tag:blogger.com,1999:blog-81767359097081511462020-06-05T01:23:31.591-07:00ParadoxUgandaDrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.comBlogger2004125tag:blogger.com,1999:blog-8176735909708151146.post-41746250644629406842020-05-31T09:56:00.000-07:002020-05-31T10:00:18.268-07:00BLM and Jesus and Pentecost and Protest: COVID-19UGANDA day 72, Easter Day 50 and out<div dir="ltr" style="text-align: left;" trbidi="on">
If anyone has staked their life on the premise that Black Lives Matter, it is every mother, every doctor, every teacher, every missionary in Africa. That phrase is a particular situational paraphrase of the Gospel: For God so loved the world, God gave everything to defeat evil and bring us life. Human beings matter and the Bible over and over speaks about God's particular love for the oppressed, the imprisoned, the lame, the sick, the orphan, the widow, the poor. The signs of the all-things-new that Jesus promised will first be seen in the transformation that begins on the margins. That is justice in real time. Yet living out the day to day slog of work and chaos in a place where a billion mostly dark-skinned people and mostly poor people live and die seems far removed from the Black Lives Matter movement this week in America, the land of our citizenship and origin.&nbsp; In fact 2020 has been one long year of watching America reel from one crisis to another.&nbsp; Scott was born in Minnesota, and before this week I doubt either of us would have anticipated that state being an epicenter of injustice. But, it turns out, <span style="font-size: large;">the deep wounds of our country are being exposed.</span><br />
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<span style="font-size: large;">Which medically speaking, is a painfully necessary step towards healing.</span><br />
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Maybe the lock-downs of COVID-19, the particular availability of social media right now, created the necessary conditions for truth to get attention. Ahmaud Arbery a jogger filmed being shot by two men who assumed the right to judge and condemn him, Breonna Taylor a young medical worker shot in her bed in the middle of the night by police who raided her apartment looking for drug-dealing evidence which did not exist, the less violent but sharply chilling power imbalance in a filmed encounter between Christian Cooper, a bird-watcher in NYC, and the woman who used a 911 call to police to intimidate and threaten him with arrest even though she was the one not keeping the law, then the stomach-wrenching 8 minutes it took to suffocate George Floyd as he gasped "I can't breathe" and later "Mama" while 4 police officers, one kneeling on his neck and two others on his back, turned a misdemeanor arrest into a reason to kill. All stories in quick succession where people in power are white and assume their right to control people they fear and suspect, who are black. In 3 out of 4 cases, they wield that power fatally.<br />
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Today is Pentecost Sunday, 50 days from Easter, the moment celebrating abundance, harvest, fruit, that God chose to send the Spirit out to explode belief from one cultural group to all.&nbsp; This is a day that showcases diversity of culture and tongue, ironically.<br />
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Our Sunday podcast happened to be from Genesis, we are on chapter 9, finishing up the Flood narrative, and as CNN broadcasts pictures of burning buildings and our medical kids in Utah prepare for mass casualties to add to the COVID-19 trauma, it didn't feel relevant. But it was. It is one of the PG-13 stories that get skipped in Sunday School, where the hero of the previous chapters ends up drunk and naked and angry, and curses one of his sons. The rainbow of grace and the fresh-start of earth don't even last a generation until one segment of humanity decides to condemn another segment to servitude. Somehow this story, rather than being one about the fragility of human heroism, the dark seed of sin we all carry and need to be rescued from, the human tendency to divide and suspect others, the generational misery of cursing and justifying violence . . . became a proof text for slavers. Europeans who wanted cheap labor to exploit the agricultural opportunities of the Americas began shipping Africans across the ocean and ignored the entire message of the Bible, choosing rather to see Africans as descendants of Ham who deserved to be crushed.&nbsp; Greed and self-promotion at the expense of others, the opposite of the message of carrying blessing to others. <span style="font-size: large;">Lord have mercy, we are all guilty of that.</span><br />
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<b>And because the national entity of the USA rests at least in part on this foundation, no matter how much we want to cover it up, the wound is not going to heal without light.</b><br />
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Our former pastor from Lawndale in Chicago posted a quote from the Rev. Martin Luther King, Jr., today, that helps explain why the riots of our childhood (I remember driving through Washington DC and seeing the boarded up and broken shops in 1968) and the riots of today make some sense:<br />
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<b><i>"Let me say as I've always said, and I will always continue to say, that riots are socially destructive and self-defeating . . .But in the final analysis, a riot is the language of the unheard. And what is it that America has failed to hear? It has failed to hear that the plight of the Negro poor has worsened over the last few years. It has failed to hear that the promises of freedom and justice have not been met. And it has failed to hear that large segments of white society are more concerned about tranquility and the status quo than about justice, equality, and humanity. And so in a real sense our nation's summers of riots are caused by our nation's winters of delay. And as long as America postpones justice, we stand in the position of having these recurrences of violence and riots over and over again."&nbsp; Dr. Martin Luther King, Jr., 1967</i></b><br />
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Fast forward 40 years; here we are again.<br />
Rewind 2000 years; we've been there before.<br />
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Jesus cared about the foreigners whose space in the outer courtyards of the temple was filled with money-changers, cared about the oppressive economics of temple-as-market that hurt the poor. So, in John 2, his opening miracle of water-to-wine prefiguring a feast, is immediately followed by a one-man riot. He takes a whip, turns over the tables, and drives everyone out. Property was definitely destroyed, money was definitely lost. But Jesus' priority in this story was righteousness and justice and access to God, instead of merchandise. He was speaking the language the unheard speak to power. And it cost him his life.<br />
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None of us can protest like Jesus. All of our attempts to redress the structural evils of this world will be mixed with mistakes, pride, power. Our daughter's roommate works for a small start-up socially conscious restaurant in Greensboro that employs people with disabilities. They were looted last night too. That is also sorrowful.<br />
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No easy answers here. Injustice that has been festering for a half millenia won't be drained in a weekend, or a week. But we do have to ask, <span style="font-size: large;">is order the pre-requisite for justice, or justice the pre-requisite for order? That's a question that requires dialogue not force, leadership from the highest levels not police and citizens fighting street-to-street.</span><br />
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And that's a question that requires us to zoom out from the details of which shop is looted and what any individual's criminal record was before death. If we ignore the history that stretches back to slavery, even to Noah, to creation, we risk plastering over the putrid wound which will only mean a more difficult surgery later.<br />
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Yesterday we climbed up to the ridge that dominates our south-eastern sky. We live on the edge of the Rwenzoris, but we mostly only see them as a dark backdrop, sun on peaks, folds with clouds. It took hours to ascend the 5000 feet from the valley to the ridge. Small dirt footpaths, clusters of homes, curious children, occasional greetings, breathless effort and heat and aching legs. Step after step. But at the top we entered the northernmost edge of the park that contains the nearly 17,000 foot peaks. We were only at 8300 feet, but that is high enough to leave all of our day-to-day behind. We entered a completely alien alpine biome of bamboo and tiny orchid-like flowers, of blowing wind and cloud, of the grunts of colobus monkeys and the singing of unseen birds. Because we are locked down in our district, we had to turn around at the top and walk back down. Soon we left the cool heights behind, and were back in banana trees and bean fields, heat and hassling. Aching legs stumbling, sliding, thirsty, hot, conspicuous, donning masks whenever we passed a home, then gasping for breath between houses. This is where we live, in the lowlands of sick kids and being spectacles, of people who are hungry, others who are drunk, of closed schools and inadequate medical supplies. But the day was a physical reminder of the rhythm of life. Keep walking the dirt paths in the villages of real people with real problems and real joys; sometimes climb up to the strong winds of God's presence blowing in something new. And then go back down.<br />
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<span style="font-size: large;">What is God doing in 2020? </span>We won't know until we can climb out of it and look back. But on Pentecost let us hope the Spirit is opening a new chapter of justice. Let us pray that the intersection of a new virus, a new vulnerability, a new dependence upon each other . . . . with a new awareness of the pervasiveness of abuse of power, inequity, loss, will lead to something new and strong and beautiful.</div>
DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-80067899235144162002020-05-28T10:09:00.002-07:002020-05-28T10:09:22.073-07:00Angry About the Plant: Nineveh, Minneapolis, hidden hearts and #COVID-19UGANDA Day 69 and Easter day 47<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;">Then God said, is it right for you to be angry about the plant?</span><br />
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<span style="font-size: x-small;"><i>(Tamar Messer Illustration)</i></span></div>
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A little background. Jonah once received a very direct word-of-the-LORD, directing him to preach truth in a major Iraqi city teaming with all sorts of people and practices his own culture considered outright wrong. He was famously reluctant to go, took a ship sailing in the opposite direction, encountered a massive storm of God's mercy which threw him into a death-and-burial like fish-belly experience. He recognised the disaster as rescue, repented, prayed, found himself spewed out on the beach and trekked off to the despicable Ninevites. His apocalyptic warnings found a shockingly receptive audience, so that God relented from disaster and saved a couple hundred thousand people. Jonah watched the non-destruction event from the shade of a vine which God provided as he sulked in the desert. When the vine withered, Jonah despaired. So God asked, is it right to be angry about the plant?<br />
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And Jonah replied, yes.<br />
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There is so much in this story that is relatable to the 2020 COVID-era missionary. For many of us, the constricted state of the legalities of our current existence feels like a burial. Food, social interactions, work, the future, any plans, any relaxation, any travel beyond a mile or two on foot, has strict limits. We are separated from our people, dreaming of Tarshish and grumbling on the dunes. Most of us haven't noticed the local government declaring a state of repentant emergency with universal sackcloth, but we do see a global openness to paring down to essentials. People are re-considering their lives, inside out. Spiritually, our staff prays with sincerity as we struggle to come to terms with a world that is beyond our control. Tomorrow will be 70 days in this state which surely sounds like a Biblical number. A lot of what we learned early on and started preaching: masks, distance, screening, hygiene, has become routine. The strictness of Uganda's lockdown has kept cases very limited. Even the too-little-too-late lockdown places have staved off the worst case scenarios.<br />
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<span style="font-size: large;">And yet . . . like Jonah, rather than being delighted, I feel cheated.</span><br />
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This week it hit me: <span style="font-size: large;">what is my plant</span>? What is the shade that God gives <b>to which I so quickly feel entitled</b>? Which seems more important than the fate of 120,000 persons who don't know how to tell their left hand from their right (children), not to mention the livestock (last verse in the book)?<br />
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And as soon as I let my heart be real, the answer is clear. I'll trek to Nineveh . . . . <b>as long as I can count on my shade-flights to see our kids and our moms once or twice a year.&nbsp;</b> For others I know the shade-plant is different. Driving in a car at will. Accessing movies or ice cream or anonymity or a break. Leaving the district every 8-10 weeks. Having family visitors, having summer interns. Electricity that works. Friends. Good things, these desert plants. God-given things. Sabbath-consistent resting things, many of them. It was not wrong to appreciate the plant; <span style="font-size: large;">but God graciously withers it to allow Jonah to see his entitlement.</span><br />
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The ancient story, with all its fantastical details, rings relevant. Jonah, and we, want to see ourselves as prophets, <b>want to be right</b>. We want to enter, preach, exit. We want God to affirm our approach with something dramatic that vindicates us. And while a bit of discomfort is certainly expected, it shouldn't be too much. We need some shade after all. After all we've given up, surely a plant isn't too much to ask?<br />
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When the plant disappears, our anger is a symptom that leads to a diagnosis. <b>I want to keep God in my box, set my limits, keep a bit of control.</b><br />
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<span style="font-size: large;">But God is wind, is storm, is disruption, is mercy. Not just for Nineveh, but for me. </span>The shrivelled plant, the beating sun, the questions, become an opportunity to crack open a hard heart, to lean into grace. To see that God actually loved the animals and children of Nineveh so dearly. To see that God was so deeply grieved for the suffering and sorrow of all of Nineveh that he was willing to shake things up for them. And then God was not content to leave Jonah in his self-righteous pout. God was also willing to shake things up for Jonah.<br />
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Where is this story playing out this week around the world? Minneapolis, for sure. The comfortable <span style="font-size: large;">narrative of a progressive place has been upended by a policeman and his knee</span>. God is shaking things up there. And if we don't let God scorch our ethnocentric assumptions, that's where we can all end up. Better to be stirred to anger now, than to be cocooned in our superiority in such a way that we end up seeing each other as sub-human, calling the police, feeling threatened by law-abiding bird-watchers, ignoring a cry of "I can't breathe."&nbsp; I've seen this graphic on a few different sites:<br />
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The story of Jonah is the story of our hearts. Socially acceptable supremacy of culture, of skin, of privilege, of education, of wealth. Any of us could end up being the police man who thinks he is justified in his use of force to get his way, who thinks the being he is holding down doesn't need to breathe. <span style="font-size: large;">Lord have mercy and burn some plants</span>, lest we find ourselves now or in a few years or decades literally or metaphorically crushing a person of colour to get what we think we need.</div>
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I want to get back to see my people sometime, and sooner feels better. But surely the 120,000 children around me are just as important to God as my travel plans. Surely it is better to have a soul that stays attentive to injustice and to evil than to have comfort. Surely it is more of a mercy to be shaken awake from our entitlements than to become a person who steals another's breath.</div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-74234434692716001082020-05-23T02:57:00.000-07:002020-05-23T09:44:09.384-07:00Lessons from the Margins: #COVID19-UGANDA day 64; Easter Day 42<div dir="ltr" style="text-align: left;" trbidi="on">
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"<b><i>Know that Christianity is always changing at the margins more profoundly than at the centre, and position yourself accordingly. Know that churches or movements with no input from the margins will die</i></b>."<br />
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The author of Global Humility bases the above argument on a pattern of stories where God uses the weak, the foreigner, the last-born, the poor to speak truth or save the day. We read this the same week that our president here in Uganda announced a slow beginning of re-opening, with the staged return of some shops and limited transport. However, in his plan, he excluded the border districts (39 out of 134). All the countries around us have many more cases than we do, perks of living in a harder-to-reach place with a strong public health system/authoritarian government. To make sure everyone knew the border districts, since some only have a small slice of border, this photo was released:<br />
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If you look closely, it is a striking visual of <span style="font-size: large;">what it means to be marginal</span>. We're Bundibugyo, half way up the left side.<br />
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Living on a margin carries some heavy implications. <span style="font-size: large;">Risk</span>, for one. We border the country with the only active Ebola epidemic and the largest number of displaced people due to conflict during the COVID era (480,000).<span style="font-size: large;"> Inconvenience,</span> for sure. Only a small percentage of foods, medicines, goods that are available in Kampala are sold here. All our legal and administrative business requires 8-hour trips and overnight stays.&nbsp;&nbsp;<span style="font-size: large;">Stigma</span>, too. When someone in Uganda wants an example of a place that is difficult, Bundibugyo comes up. The idea of being last educationally and economically seeps in. <span style="font-size: large;">Scraps,</span> the left-overs, are our staple. The margins do not get the main share of the country's opportunities. Certainly we're feeling that right now: we still cannot drive, cannot leave, will have major challenges even re-opening Christ School for the seniors which is allowed to begin June 4.<br />
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<span style="font-size: large;">And yet.</span><br />
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Everyone wants to be resilient, but on the margins one learns that <span style="font-size: large;">resilience is born out of hardship and limitation. The margins have to be gritty, have to be creative, have to collaborate locally. </span>The margins are less invested in the status quo, more open to change. And the margins, Jesus says, are loved by God in particular ways. The widow and orphan, the poor and oppressed, are mentioned over and over as the inheritors of the Kingdom. The first shall be last and the last shall be first. The Kingdom belongs to such as these.<br />
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This has some practical implications on which one can stake a life.<br />
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<li>Grace at the Fray, the Serge motto, means that if you're looking for the Spirit, for life, for outpouring of mercy, then head to the fraying edge. Glad to be part of an organisation that takes this literally.&nbsp;</li>
<li>If you find yourself on such a margin, don't despair. Look for the unexpected. Jesus was born in a cave where animals were sheltered, not a 5-star private hospital.&nbsp;</li>
<li>And if you don't find yourself at a margin, <b>pay attention to what the margins are showing the world, what the poor are saying, what those with less power see and know.</b>&nbsp; Read widely. Make friends with people whose life experience gives them a view that might change your own assumptions. I learned the term "narrative violation" this week, and I think that is what art and literature at their best can offer. Most of Jerusalem's power brokers saw Jesus as a troublesome crowd-rouser who broke the rules, mixed with the wrong sort, threatened a way of life, and was justly disposed of. But the women who came to the tomb at Easter saw a gardener who knew their name and quietly reversed death. Both stories circulated; we still have to choose which to embrace.</li>
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<span style="font-size: large;">Back to the photo at the top.</span></div>
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That's the morning gathering of staff at our local government hospital. They are making about $5-$10 a day, and that's considerably more than the average citizen but hardly enough to pay for food, electricity, transport, clothes, school for their extended network of dependants. Yet there they are, day after day, grappling with how to care for the never-ending stream of patients, with the too-soon-ending supply of medicine and tubing and electricity. And in this photo, everyone is smiling under those masks. Because our team in Fort Portal, Jenna and Pat, had their <b>Green Leaf Crafts</b> women's sewing coop make a couple dozen masks to donate to hospital workers. These arrived just as the hospital was completely out of surgical masks, and the leadership had to shut down access to our donated N-95's because they were leaking out to the streets. A nice re-usable cloth mask costs a dollar or two; a simple one being made on the street costs less than fifty cents. But that cost is a barrier and so yesterday morning there was rejoicing. Masks were made mandatory in Uganda, and we know they are necessary in the hospital. <span style="font-size: large;">This is a photo of people who know that it makes sense to take precautions, and who are grateful to be able to do so.</span></div>
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Contrast that with the growing politicisation of mask-wearing in some countries. Rather than being thankful for a way to protect others, we see people demanding their "right" to be a public source of harm. Suddenly wearing a mask is equilibrated with a whole host of political leanings rather than being a universal sign of kindness to society. Looking from the margins in, we note people videoing THEMSELVES in Costco without masks as if they are freedom-fighting heroes, and it frankly looks absurd. Marginal places that have fought COVID-19 successfully have relied on these basics:</div>
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<li>HYGIENE: Washing hands, again, and again, and again. This includes cleaning surfaces and using hand sanitiser.</li>
<li>SCREENING: Staying home if you are sick. Not allowing sick people to come to work. I really can't believe the videos of people purposely coughing on each other!! Though I suppose in a universe where people find it their right to shoot each other it makes twisted sense. But really, we are in an epidemic of a disease that just put a friend of ours in the hospital with a whole-body rash, a blood clot, low blood pressure. She's a nurse and way younger than I am. This is real. Our pastor's family's school colleagues have TWO CHILDREN IN INTENSIVE CARE from coronavirus on maximal life support. How can you want to cough and spit and sneeze when you see body bags stacking up?</li>
<li>DISTANCING: stay at least 6 feet apart, 2 meters, though Uganda changed that to 4 meters in some situations. If you do your visits outdoors with breeze and sunshine, the risk plummets.&nbsp;</li>
<li>MASKS: when you can't stay far apart, when you're in public, when you're working in closer quarters, wear a mask. This protects others, and is particularly important because this disease has a peak of infectivity just before symptoms start, and a huge under-the-surface iceberg of infected people with no symptoms at all. When I walk to the market with a cloth mask on, I'm not really protecting myself so much as protecting others in case I HAPPEN TO BE on the verge of illness.&nbsp;</li>
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Back in March, we read about the above making an impact in Singapore, and&nbsp;<span style="font-size: large;">started all four of the measures in Bundibugyo.</span> We bought sanitizers and invested in bleach for the hospital and mission. The hospital set up screening at the gate, with temperature checks and questions, and we did at our mission too. We started holding our staff and team meetings outdoors standing or sitting far apart, and suspended the activities where this could not happen like church and school. And we started wearing masks all day at work, every day. Now we also wear them in public, everywhere we go. These are measures that low and middle income countries around the world have embraced. Marginal people know they won't get on a ventilator, they won't be on an experimental remdesevir protocol, they probably won't even get oxygen. Marginal people know that they have to take some steps that are sacrificial for the long-term good of their elderly relatives, for the communal good of their clan.&nbsp;</div>
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So here, on the margins, you see people trying to comply. Here, the the problems we hear are that people are out of soap, can't afford to buy more. Or struggle to pay for those 50-cent re-washable cloth masks. Here we hear about thieves stealing someone's crops right out of the garden, or taking their chicken at night, not about their demand to buy beer with an uncovered face. Here there is evil and need and breakdown and sorrow, but there is also a <span style="font-size: large;">strong will to survive, a determination to do what we can to make it through</span>. The president here begins his addresses now with his mask on as an example, and has everyone around him spaced out in 6-feet increments and all wearing masks as well. Public figures sense the need to pay attention to the facts, to lead in practice as well as in words.</div>
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Uganda <a href="https://gh.bmj.com/pages/wp-content/uploads/sites/58/2020/05/BMJGH-The_potential_effects_of_widespread_community_transmission_of_SARS-CoV-2_infection_in_the_WHO_African_Region_a_predictive_model-Copy.pdf" target="_blank">is projected</a> to have 6 million infections, 122 thousand admissions, and 2600 deaths . . . though the continent-wide impact could be up to 250 million infections and nearly 300 thousand deaths. Not as bad as malaria; but malaria won't stop for COVID either, so this will nearly double the toll. All to say, that here in what the power/wealth centers of the world looks like a margin, our public health measures <a href="https://publichealth.yale.edu/news-article/24397/" target="_blank">aren't going to spare us</a> completely. But they are going to soften the brunt of the blow. And organisations <a href="https://serge.org/" target="_blank">like ours</a> and many others are <a href="https://give.serge.org/p-31-bundibugyo-medical-project.aspx" target="_blank">buying more oxygen capacity</a>, helping people who have no safety net living day-to-day in informal urban settlements buy food, procuring masks and soap, <a href="https://give.serge.org/p-741-christ-school-bundibugyo-one-time-needs.aspx" target="_blank">paying staff as a matter of justice</a> even in times of economic slump.&nbsp; There is work to be done for sure, and we have a long way to go. But there is hope too, in listening to the basics and enacting sturdy measures. (Yes, the population is also younger, but please don't tell me that as an excuse. A young population to Western ears where the culture is obsessed with youth, beauty, health, immortality, fitness, sounds enviable. In reality it means that people die earlier of other things. Once you are born, you will eventually die, so if most people are young that means that most people who are born aren't making it to 50, 60, 70 and beyond.)</div>
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Atul Gawande, a prolific surgeon and writer associated with Harvard in the USA, <a href="https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry" target="_blank">writes about</a> the measures that work and adds a fifth: <span style="font-size: large;">a change in culture.</span> Because hygiene, screening, distance and masks <span style="font-size: large;">all boil down to behaviour, and behaviour is driven by belief</span>. On the margins, people see death up close and personal, day in day out. We have lived through Ebola here. We have lost those we love. We know that virae are real, deadly, and passable from person to person. We believe in protective barriers and limitations to freedom for seasons, in order to fight a disease.&nbsp;</div>
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By reading, following, donating, you are positioning yourself here in the margins with us, and we are grateful for your prayers. In turn, we pray for culture change in the center that will save lives, build bridges of unity and empathy, and bend the arc of our collective story towards justice as Jesus promised.</div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-82974689285643935022020-05-19T11:35:00.003-07:002020-05-19T11:35:40.267-07:00Complex Proximity: #COVID-19UGANDA day 60, going on 600<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;">"Proximity helps us to appreciate complexity. It begets empathy. . . prohibits simplistic solutions.. . causes us to be emotionally invested in the issues. Proximity, then, should be a priority. Mission that is not up-close-and-personal is inadequate."</span> (McCullough, Global Humility)<br />
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The call to prayer echoes in the darkness, moonlight on the mosquito net. Fighting this rhythm is a losing battle so we embrace it and stretch to meet the day while it is still the cool hour of stars fading, the outline of palms against the greying sky. A bit of routine anchors the day: exercise, Bible reading, coffee, prayer, breakfast, quick check of news and communication, then out the door. Masks on. We have a permit to drive the 8 miles to Bundibugyo Hospital, with maximum of 3 people in the car. Ivan, a final-year nursing student who grew up with our kids, usually waits just at the road to ride with us, as we open and close the gate to keep our rambunctious dogs in the yard. The mountains are clear, sharp, jagged. We used to see snow routinely on the peaks. This year, none so far. But the way the road hugs the ridges that flow into the valley turns us towards the mountains as we climb, and I always think of Psalm 121, my Dad's favourite.<br />
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The 8 am staff meeting trickles to a start as we park in the dirt lot in front of the administration building. We stand a meter or two apart in a semi-circle. A different staff member is tasked to chair the meeting each week, choosing someone to offer the opening and closing prayer, asking for the night nurse's report. 15 admissions to Paediatrics, one death, total on the 25-bed ward is 55 or 63 or whatever the day holds. 5 C-sections over the last 24 hours. 8 babies in NICU. 25 on male ward, and can one of the doctors please review bed 17? And so on. Then there is open reaction, and inevitably, the tenor is this: we couldn't give medicines because the key was missing, there is no more artesunate, we couldn't call the on-call doctor because we had no airtime, we are out of guaze, there is no sterile gown for the next surgery, there is no suture, can we please buy a bulb syringe because we almost lost a baby for lack of suction, we are out of A+ blood. <span style="font-size: large;">This entire system hangs by a million fragile threads. Matters of a few dollars are life and death.</span> There is so little margin. Yet I admire the process, the attempt to build teamwork, the value on every person being heard, the courage to plug on in spite of a thousand barriers.<br />
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From there we disperse to the wards. Scott begins seeing all the women on maternity. I start in NICU then move to Paeds ward. At times we are alone, doing vital signs, getting history, examining, writing notes. Squat and lean over the patients on the floors, stand and discuss. Scott lugs the ultrasound and a bp cuff, I have my hand santizer and a bag of gloves, a pulse oximeter. The masks make communication even more frustrating. At times a student or volunteer tags along, helpfully filling out lab forms, repeating my instructions to help moms understand. Most days our colleagues Dr. Isaiah and Dr. Ammon come in and out, as we choose the busiest wards and they know we need help, but they are also pulled to this politician's sister and this staff member's grandfather. I try my best to note the sickest first, but inevitably I find a child severely ill on my last section of beds. Or a nurse brings in an actively convulsing new admission. My methodical march through the ward always takes turns and detours. Scott ends up with a C-section, or does extra ultrasounds. Jessie and her team point out a child from their nutrition office who needs labs, or who is not improving. I call Dr. Isaiah or Ammon for advice, or the lab in-charge to find out if the machine for bilirubin happens to be working today. I try to focus on each kid, say a prayer as I listen to a chest, not let my mind wander to the next problem, be alert to a clue of a rash or a paleness or a story that doesn't quite fit together. As I see patients I direct them into a small room where nurses sit and inject our limited options, either an antimalarial or one of two antibiotics. Others go into the opposite side room and get tablets for going home, others are given therapeutic food from the nutrition team. Others are placed on one of the three tables in the front where they get a blood transfusion, or some IV fluids, or oxygen.<br />
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In the late afternoon, I am toast. It is hot. The masks make it feel suffocatingly so. There are always more problems than we can manage. By 1, or 2, or 3 we wind down, perhaps we run to the pharmacy to spend $20 or $30 on stop-gap medicine measures, to buy ng tubes or ORS. Then it is back into the car, switching the N-95 mask for the cloth non-medical mask. I let my N-95 bake in the sun of the dashboard as I will reuse it for at least 6 days. More alcohol swabbing of everything. Uganda cases are almost all truck drivers at this point, but the march of the virus through Africa is inevitable. The WHO expects 250 million cases. It is hard to imagine.<br />
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Back at home, we often have a scheduled meeting, in person with a team mate (socially distanced outside!) or by facetime or other internet medium with a team leader around our area. Today Scott and Patrick spent hours pouring over budgets, because the schools have permission to open in two weeks ONLY FOR THE SENIORS . . . we struggle with the justice of paying our staff, verses the financial reality that every month we lose $5,600 because parents are not paying tuition. When we bring back just 1/6 of the students, continue to pay staff, and resume providing meals for everyone, the losses will continue at about the same pace. The reality of coronavirus never quite recedes to the background. Not just the finances. The masks, the curfews, the limited movement. The uncertainty. Will we ever be able to bring the rest of the students back? What will this mean for the longterm education of this generation? As frustrated as we are with all of that, coronavirus also hits home personally. We listen to a nurse friend tell us about her diagnosis of COVID after her brave few weeks of work in NYC. She has a full body inflammatory rash, a racing heart and low blood pressure. Coronavirus is not just about inconvenience and politics. It is about the random but real young healthy person who develops severe symptoms and lands in a hospital bed. Pray for Allyson.<br />
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In the evening we were about to zip down to the market town for milk, but as we come out of the gate, we spot a Great Blue Turaco and have to stop and watch. In the past week we've also seen a crested eagle, and a hornbill. Scott waters the garden and I scavange for dropped mangos and avacados under the trees. All our shopping is on foot, unless a team mate has organized a small cargo delivery from Fort Portal. There are phone calls with moms and kids and sisters, news, or catching up on the latest rules from the President, or preparing for the next day as we make dinner and wind up the day.<br />
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The needs of Bundibugyo and the joys of Bundibugyo are complex. They are intertwined. And impossible to understand from a distance. Only by walking through a day, and another, and another, by touching the sick, fumbling with Lubwisi under a mask, praying with a team mate, strolling in the heat to buy tomatoes, answering another knock from a person with a problem, figuring out how to improvise when the incubator doesn't work . . . <span style="font-size: large;">only by being right in the mire of the world do we get to be on the front row for redemption.&nbsp;</span><br />
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-80835433605441261932020-05-17T10:15:00.000-07:002020-05-17T10:15:12.740-07:00The Wind at Your Back: #COVID-19 day 58; Easter Day 35<div dir="ltr" style="text-align: left;" trbidi="on">
Four years ago we were heading into our previous company conference, from which we would leave a bit early to attend Caleb's graduation from the USAFA. President Obama was his graduation speaker. Yesterday, Obama spoke online for the class of 2020 collectively, a generation of students leaving high school and college at a fragile time. So it was with a bit of nostalgia that we listened to both versions of his address. Much of it was vintage wisdom of the sort one expects from our leaders, tempered by the truth that no one truly knows what the rest of 2020 will bring, or how profound the impact of this time will be on the world our graduates inherit. He told the high schoolers to have courage, to stick to their values and do what they know is right, and to do that in community. He told the college grads a similar thing: be grounded in real local actions, work with others, seek justice for everyone. To all that we can say, AMEN.<br />
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<i><span style="font-size: x-small;">Dr. Isaiah graduated last year, and nurse Ivan is due to graduate in June . . may we have grace to let THEM plan the new NICU care!</span></i></div>
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Already we can sense a deeper awareness of the smallness of the planet. We interact with our natural environment at seven billion points, and this time the point where a virus jumped species happened to occur in China. Last time it was the DRC. Next time it might be Brazil. The interconnectedness of humanity carries promise as well as potential disaster. And the impact of such disasters is not felt equally around the world: the poor suffer disproportionately from climate effects, from disease, from recession. Obama's points about global thinking and virtual access needing to be combined with local action and community rang true. All change starts with real people and places, with problems being identified and solved in specific locales and times.&nbsp; We are better when we sharpen and push each other. No one gets to graduation day without help, and the best changes are ones that are refined by others. I hope his words are heard this weekend as a call to hope. And a call to thoughtful engagement with the world. Nothing beats proximity for building empathy and ideas. We need graduates to take risks and reach difficult places, to let the hard days spark ideas and faith. We can use many of those with us in Serge.<br />
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But it was his final phrase that stuck with me today: <span style="font-size: large;">as you set out to change the world, we will be the wind at your back.&nbsp;</span><br />
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I'm just a year younger than our former president, and I found that encapsulation of our generation's role to be poetically succinct. It is our children who will reshape the post-COVID world. They are already restlessly aware of inequality, of the shallow promise of unfettered greed. They are already thinking about what makes a service essential, of careers that have been necessary when things fall apart. They are already on the front lines of risk, and thoughtfully seeking community.<br />
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The wind at their back. The spirit blows where it will. Let us have the graceful humility to empower the story whose plot-line is shifting to them. Let us encourage, enable, inspire, cheer.<br />
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Because isn't that how God works for us too? A still small whisper, a bruised reed, an invitation. A wind at our backs that sent us out here to the frayed edge, a breeze that directs and refreshes but does not force. When the seasons change here, the wind blows. Let us be part of that change without needing to control it.<br />
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-1904212010646368622020-05-14T02:20:00.002-07:002020-05-14T02:21:25.580-07:00Of Floods and Thrones: seeing God in the chaos (#COVID-19UGANDA day 55; Easter day 32)<div dir="ltr" style="text-align: left;" trbidi="on">
A week ago this morning, foaming walls of water crashed from the Rwenzoris down into rivers on both sides of the range. People in Busunga, on our DRC border, awoke in the night to the sound of water and chaos, and grabbed their kids to move to higher ground. By daylight we joined thousands of others to go and see what we could do to help. By the end of the day, our administrator John had already enlisted Christ School graduates to canvas the affected area home by home, enrolling those who had lost the most. We learned a lot from our work with the December flood response. This time it took some extra steps for permission to travel and procure relief supplies because of COVID lockdowns, and to organize a bit of protective social distance into the distribution. But letters were granted, a truck arranged and filled. Monday night we were lugging mattresses and bags of rice in the dark into our long-closed community center, stacking items in the darkness. Tuesday clean-up and preparation, and Wednesday (yesterday) the joy of giving it all away.<br />
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We are called to be the <span style="font-size: large;">community of care that makes suffering possible to absorb</span>, an apt phrase from Hauerwas quoted by Eric McLaughlin. Here is a bit of what that community looks like.<b> First, the neighbours, the general population </b>that hears "flood" and thinks "go towards the crisis." That caught our attention, so <b>we went too.</b> You have to bear witness, to be present. Nothing replaces actually walking into the mud and water, actually seeing the rushing power, talking to those who lost their livelihoods. <b>Second, the team</b> including our handful of Ugandan staff like John, with can-do organization and ideas. <b>Third, the broader network of Christ School alumni, </b>young people with whom we had 4-6 years of mentoring, who have developed hearts of service and are willing to wade in with us and work. <b>Fourth, the great cloud of witnesses in the literal icloud</b>, the global community of the prayerful, who in the midst of their own pandemic see pictures of devastation far away and want to help. Because of first-responder generosity, we took the immediate six thousand dollars that came in and borrowed nine thousand from our other funds and approved the aid package. Six days post flood we were able to give each of 125 families a new mattress, bed sheets, blanket, plates, cups, cooking oil, beans, rice, and even a bit of cash to hire a motorcycle to drive it the 8 km back to their home.<br />
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If you <a href="https://give.serge.org/p-775-bundibugyo-emergency-relief-fund.aspx">would like to join those first-responders</a>, please help us make up the rest. I contacted the initial 21 donors last night, and found several widows on limited incomes, students, a person working two minimum-wage part-time jobs who decided to donate their government-stimulus check because unlike many others, they had remained employed as an essential worker. We're not talking about people giving out of excess of comfort, we're talking about real sacrifice. The community of care, layering through multiple crises, stretching around the world. Missionaries living proximate to see and connect and act, local people with the willingness and skills to get things done, donors with hearts to participate. And then the recipients, who get to see love in action. We all need each other.<br />
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The sudden devastating force of unstoppable water that upended hundreds of lives last week is just a visible form of the same kind of frightening danger that spread around the world this year as a coronavirus too subtle to see. This morning, 4.3 million known cases and almost 300,000 deaths; when all is said and done the official toll numbers probably will represent only a fraction of the true picture. We can feel paralyzed by the enormity of the situation. <span style="font-size: large;">Yet two things remain true: God is still bringing the Kingdom to come, good to be done, here on earth. And God's people are the primary means by which this happens, as grandmothers stay isolated in spite of loneliness and nurses work long risky shifts and all of us pitch in our resources to help our neighbours near and far</span>.<br />
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I've been reading quite a bit in Psalms, and this week both 29, 32, 69 and 93 all mentioned floods. I would imagine that the topography and climate of gullies and hills and storms would mean the force and destruction of uncontrollable water was something people would have experienced, and <b>an apt metaphor for the powerlessness we feel in the face of forces beyond our control. The point of the picture: these are not beyond God's control.</b><br />
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<i>The voice of the LORD is over the waters;&nbsp;</i></div>
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<i>The God of glory thunders;</i></div>
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<i>The LORD is over the many waters.</i></div>
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<i>The voice of the LORD is powerful;</i></div>
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<i>The voice of the LORD is full of majesty. . .&nbsp;</i></div>
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<i>The LORD sat enthroned about the Flood,</i></div>
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<i>And the LORD sits as King forever.</i></div>
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<i>The LORD will give strength to His people;</i></div>
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<i>The LORD will bless His people with peace. .&nbsp; .&nbsp;</i></div>
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<i>The floods have lifted up, O LORD,</i></div>
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<i>The floods have lifted up their voice;</i></div>
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<i>The floods lift up their waves.</i></div>
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<i>The LORD on high is mightier&nbsp;</i></div>
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<i>Than the noise of many waters,</i></div>
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<i>Than the mighty waves of the sea.'</i></div>
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Let us, by faith, affirm that the mighty roar of waters cannot dethrone our God, nor can the destructive seep of the coronavirus around our planet. We have help in high places. In fact we are staking our lives upon it.</div>
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(<b><i>Watch the short video of the distribution here to lift your spirits today: <a href="https://vimeo.com/418059739" target="_blank"><span style="font-size: x-large;">link here</span>)</a></i></b></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-46585976778364374112020-05-09T05:56:00.002-07:002020-05-09T05:59:46.332-07:00#Bundibugyofloods ROUND TWO (also #COVID-19Uganda day 51 and Easter day 29): A COMMUNITY OF CARE IN THE FACE OF EVIL<div dir="ltr" style="text-align: left;" trbidi="on">
Torrential floods raged through 122 homes, <a href="https://give.serge.org/p-775-bundibugyo-emergency-relief-fund.aspx"><span style="color: red;">link here</span> </a>to help, full story below.<br />
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Thursday we were awakened in the wee hours with the thundering sound of heavy rain on our corrugated metal roof. Before dawn, there were dozens of groups of people on the road, unusual in any time but particularly in this time of restriction and curfew, a buzz of talking and movement. I went out and talked to neighbours and heard the news: floods had hit us again, this time <span style="font-size: large;">a flash flood of the Lamia River</span> which descends from the Rwenzoris and forms part of our Congo border.<br />
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By full daylight Scott and I had driven the 8 km to the border to see what had happened, encountering literally more than a thousand people along the way. The absolute instinct of this culture is to gather towards loss, to move into the place of grief. Some of that is related to the interconnectedness of family-clan-tribe; it is not difficult for most to trace a line of relation to a person. Some is a spiritual drive to be on the side of the victim not the perpetrator. Some is human curiosity. And some is the fact that after 50 days of lockdown a remarkable number of people are willing to walk 8km to be together.<br />
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<b><a href="https://vimeo.com/416638651"><span style="color: red;">The video</span> </a>shows what we found Thursday morning</b>. Our border river flows down from the Rwenzoris, and the mountains had heavy rainfall. Seasonal variations affected by the increased temperatures of the world, plus population growth with clearing and farming reaching higher elevations and lowland bogs or wetlands being filled . . .means that a massive rainfall on the mountains resulted in torrential river flows on the north-west side (us) and south-east side (Kasese). The Lamia river diverted upstream into two, and one branch flowed right through Busunga town. Unlike the December floods, this one was not a landslide on a steep slope (no destructive rocks tearing down houses), it was a raging river of mud and water sweeping through. Because of the area, 50% more homes than December were affected, but with less loss of life and structure. One UPDF soldier patrolling the border was swept away and drowned; we saw his body being carefully repatriated from the Congo side over the bridge. Others were missing, but I have not heard of more deaths. Miraculously people heard the water and moved their children to higher ground.<br />
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One reality of poverty is that property is often on ground level--not so many homes have storage in higher shelves and cabinets and attics. So a sweeping flood like this means that mattresses, sheets, clothes, dishes, papers, tools, keys, lamps, anything in the house was likely ruined or lost.<br />
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Five months ago we asked you readers to help 85 families in the landslide area, and you gave so generously we were able to bless them those in the epicenter with resettlement packages, then perform ongoing nutritional surveys and supplements for the displaced more broadly, and even contribute $17,000 towards the re-build of the destroyed clean water pipeline system. That effort truly communicated God's presence and care. On Thursday and Friday we once again mobilized Christ School graduates to register people whose homes were severely flooded. <span style="font-size: large;">We have a list of 122 homes, 856 people.</span> Our four young men went into each home and verified the damage and loss. Buying and distributing mattresses, sheets, rice, beans, oil, jerry cans, blankets . . basic survival items . . will be much more challenging in this era where we are not allowed to drive or gather. But we intend to make it work.<br />
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Uganda is suffering from multiple plagues at once. In the north, a once-in-fifty-year level of desert locusts has descended, devouring crops. In the Lake, an out-of-control proliferation of invasive vegetation has blocked the main power-generating dam, cutting down electricity. In the West, we are having massive rainfalls leading to flooding, plus the subsequent spike in deadly malaria and gastroenteritis. All in the context of the pandemic of coronavirus, which has locked us down to a small area, severely impacted the economy, and left us bracing for a wave of death.<br />
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This week in <a href="https://newgrowthpress.com/promises-in-the-dark-walking-with-those-in-need-without-losing-heart/">Promises in the Dark</a> we read: "Hauerwas says, '<span style="font-size: large;">Historically, Christians provided not a 'solution' to the problem of evil but a community of care that made suffering possible to absorb.' . . .Maybe this community of care that makes suffering possible to absorb is, in fact, the emphatic presence of God's goodness."</span><br />
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In fact, as we began 2020, we heard over and over that the prompt presence that we were able to show in December spoke volumes to the local community. Help was needed then, and it is needed again, and while there are massive gears that will eventually turn, you can help us be a quick first-response. There is so much right now that we can't even begin to fix, but perhaps this one thing we can do.</div>
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<b>Would you be part of that presence with us? <a href="https://give.serge.org/p-775-bundibugyo-emergency-relief-fund.aspx"><span style="color: red;">LINK HERE TO DONATION PAGE</span> .</a></b></div>
DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-69214898252607863482020-05-02T02:00:00.001-07:002020-05-02T02:00:21.137-07:00#COVID-19UGANDA day 43, Easter day 21: public health, justice, and the constricted life<div dir="ltr" style="text-align: left;" trbidi="on">
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We made it to May. Congratulations to everyone in the deep red circles. A third of the world's cases are now in the USA, and our hearts are with our country-of-origin. In the great levelling reversal of this epidemic, we tune in almost every night to Cuomo's press briefing, just as the world has often watched Africa on the nightly news. We follow partly to grow with empathy, partly to learn where we might be in another month, or another six months. The map strikes me as a graphic of the first shall be last and the last shall be first.<br />
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Here in Uganda, I have to hand it to the <span style="font-size: large;">public health mindset</span>. This is a place that has soldiered through AIDS, Ebola, and war with very limited resources, yet generally outpaces its neighbours on measures of delivery of preventive type services. As our current cycle of sort-of-lock-down reaches its limit on Tuesday, we await the next plan. Right now the rules are: borders closed except to cargo trucks (no planes, no buses, no public crossing), no public transportation in the entire country, no driving a private vehicle anywhere, no churches, no schools, no public gatherings, no weddings or funerals of more than 10 people, no outdoor exercise at any time, curfew in place for no movement at all even by foot 7 pm to 6:30 am. Market sellers are supposed to sleep in the market and not move back and forth to home, as are factory workers. Food and medicine can still be sold, but all other shops are closed. Hospitals are open, and the top government official in each district authorises limited transport for patients and health care workers to and from the units. <span style="font-size: large;">The ideal expectation </span>is that each family is hunkered on their own compound of small houses and working daily with their hoes and machetes to garden food. <span style="font-size: large;">The reality is</span> that small groups of people move up and down the road on foot continuously, people sell piles of tomatoes or onions or matoke from mats on the roadside or tables under their eves, motorcycles zoom around with bundles of wood and packages of bread, kids roam and neighbours visit, patients have crowded back to the hospitals, and our work is as busy as ever without the conveniences we used to lean on or any sure timeline of a break.<br />
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Nevertheless, we have only 85 cumulative positive tests out of 33,818 tests done. Almost all of those are either Ugandans who returned from working in the Middle East in March and have now recovered, or Kenyan and Tanzanian truck drivers who are moving cargo. That's 0.2% positive tests (# positive out of all tests done), representing 0.0002% of population positive (# positive out of Uganda's 43 million people) after testing approximately 0.08% of the population (# tested out of Uganda's 43 million people). In the USA those numbers are 17% positive tests, representing 0.34% of the population positive after testing 2% of the population. America has tested 30x as many people relatively, but has almost 2000x the relative infection proportion. Because all the numbers are still so low, it is hard to know the truth. Uganda is testing returning travellers and truck drivers mostly, not just symptomatic people. America is testing hospitalised people mostly, not travellers, so it makes sense to find more illness. To help account for this, Uganda has embarked upon a country-wide sample to assess hidden community spread. This is going to bring in more helpful information.<br />
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Kenya has more cases, and most of theirs are community-transmitted. Even within East Africa inequalities abound. Burundi is our most hard-to-reach country, with fewest cases and a reluctance to test; Rwanda, Tanzania and Kenya are more connected, with more cases. Uganda is in between. DRC has many cases in the Kinshasa area but few in the East near our border, similar to South Sudan. Again, the great reversals of the Kingdom: if it's a hard-to-reach hard-to-stay place it is less likely to be overwhelmed by coronavirus yet, but more likely to have little ability to fight the disease once it takes hold. Therefore the strict measures to try and keep it out. The East African Federation is floating ideas of a self-sufficient region connected by trade via cargo trucks where the truck drivers have their own designated non-mingling safe houses along all the routes.<br />
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And as the pandemic machinery grinds on, money flows. Mostly of course to pharmaceutical companies eager to develop treatments and vaccines, trying to appear objective and community minded though we should all maintain healthy skepticism. But also it trickles even to Bundibugyo. Though other teams have been able to begin some quiet relief distributions in the face of economic stress (Nairobi mostly), here in Uganda the government decided to control all perceptions of largesse, so any funding has to be given to the government.&nbsp; 43 days later we hear that trucks of food will arrive soon, and there was a near revolt amongst health workers over the perception that risk-pay salary bonuses might be distributed unequally based on risk-taken rather than given to any and all whether they work or not. The values of this culture are very very strong for sharing benefits, and very quick to protest any perceived reward that is not whittled down to everyone getting a piece. On a macro level, the medical journal <a href="https://www.thelancet.com/action/showPdf?pii=S2214-109X%2820%2930135-2">The Lancet in April</a> published a commentary on the economics of this pandemic, noting that the US and Europe have poured money into their own economies while quickly fleeing from emerging markets to the tune of $83 billion, the largest resource shift ever recorded. The answer has been to expect IMF and World Bank to take up the slack, which they are doing by advising more loans with more interest, more cutbacks to services and salaries in low and middle income countries. Even money earmarked for health care will largely flow to private companies. The authors conclude:<i> For decades, international financial institutions have
pursued policies that undermine public health systems,
allowing billions of people to remain without adequate
health care. The COVID-19 pandemic is an opportunity
to do things differently.&nbsp;&nbsp;</i><br />
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So that is where we stand on a cloudy Saturday on the edge of the rainforest, picking up mangos and avocados from our trees, watching the world, wondering what is true, and returning once again to the basics. 27 out of 29 people on our team have been sick in the last few weeks with yet another viral crud, not corona. The good news is that most everyone is improving and we probably flattened our little crud curve from days to weeks; the bad news is that in spite of thinking we were taking precautions like meeting outside, chairs far apart, canceling events, trying to keep sick kids inside, not having shared meals, not having team worship . . . this team lives like a big family.<b> In a time of social constriction, we have stayed spiritually and emotionally connected but at a considerable physical cost,</b> and we soberly admit that once corona comes, as abnormally as we are living now it is going to get even harder.<br />
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<a href="https://1.bp.blogspot.com/-QeWN_G3ox0o/Xq0zht0qaHI/AAAAAAAAWyw/jEDJcmvaKccnKXxbYcGR6bEp5te86OzxACLcBGAsYHQ/s1600/josh%2Bwater%2Bproject%2Brocks%2Bpipe.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="1280" data-original-width="854" height="320" src="https://1.bp.blogspot.com/-QeWN_G3ox0o/Xq0zht0qaHI/AAAAAAAAWyw/jEDJcmvaKccnKXxbYcGR6bEp5te86OzxACLcBGAsYHQ/s320/josh%2Bwater%2Bproject%2Brocks%2Bpipe.jpeg" width="213" /></a><br />
<span style="font-size: large;">In the meantime,</span> Josh has embarked upon the huge task of rebuilding the main water system destroyed in the landslides. Ike works on mission infrastructure and occasionally arranges fresh vegetables or other staples to be delivered by motorcyle. Mike is beginning to delve into helping John with accounting and administration, while responding to a request to deliver a written sermon to our locked-down church members in the community. Jessie, Kacie, Marc, Scott and I join our Ugandan colleagues (when well) to keep delivering food for the hungry kids, malaria treatment, safe deliveries, titration of feeds for prematures, soaking of wounds and measuring breathing, slogging through long rounds or rushing into emergency surgeries. Ann has re-organized the library space and encourages anxious visitors who come to her for comfort. Lindsey, Alexis, Anna and Patrick teach kids when enough are well, and plan for next year's school plus mentor CSB leaders. Patrick has taken on the CSB communication role, and we know funds will be needed since we are still paying staff as a matter of justice even though parents are not paying fees. Students have received their second round of home-delivered packets of work, and our kitchen/grounds staff are working in the CSB garden. Stephanie's literacy program teachers are reading books on the radio, and teaching phonics songs on-air. Lubwisi language helpers still slip onto the mission to teach our newest team mates. Neighbours still come knocking every day with their stories of high food prices and unpaid salaries and needing loans. We still pray in staff meetings and on wards, still point to Jesus as our source of help and hope. When we walk up and down, we receive cheery greetings, and hope and believe that the small humble inputs and the continued presence of this team communicates a bit of global Kingdom solidarity, and the love of God.<br />
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Like the rest of the world, we are constricted to this small space and time. We don't know what next week or month holds. We don't know when we will get a respite, or more coffee beans, or mail delivery. We don't know what we can do if a real emergency arises. We don't know when coronavirus will trickle its way into larger portions of our environs, so we live on alert and in the dark. We make decisions as best we can, <span style="font-size: large;">we embrace waiting and praying and reading and hoping and serving. Which is, in effect, embracing a life. Even a small one can be a deep one.</span><br />
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<a href="https://1.bp.blogspot.com/-BiW3v5bJ46k/Xq0zjxx175I/AAAAAAAAWzQ/4GU-LfpVxmsF-xJj0yc70ZgcVLxUENNJgCLcBGAsYHQ/s1600/project%2Bpipes%2Bveiw%2Bout.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="854" data-original-width="1280" height="213" src="https://1.bp.blogspot.com/-BiW3v5bJ46k/Xq0zjxx175I/AAAAAAAAWzQ/4GU-LfpVxmsF-xJj0yc70ZgcVLxUENNJgCLcBGAsYHQ/s320/project%2Bpipes%2Bveiw%2Bout.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>Another view of the project beginning, note the height!</i></span></div>
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<a href="https://1.bp.blogspot.com/-LBeiigQeRi4/Xq0zgesH0eI/AAAAAAAAWys/6likVcnAvHsjjPAEaQidE2tmtp68pNYuQCLcBGAsYHQ/s1600/back%2Bto%2Bpatients%2Bon%2Bfloor.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-LBeiigQeRi4/Xq0zgesH0eI/AAAAAAAAWys/6likVcnAvHsjjPAEaQidE2tmtp68pNYuQCLcBGAsYHQ/s320/back%2Bto%2Bpatients%2Bon%2Bfloor.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Back to filling up the floors . . .&nbsp;</i></span></div>
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<a href="https://1.bp.blogspot.com/-JKejoGJKBNQ/Xq0zgduSrRI/AAAAAAAAWyo/xjIUgX3aG94_6XFF3KjHxHY35qp0AI1iACLcBGAsYHQ/s1600/child%2Bwith%2Bkwashiorkor.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-JKejoGJKBNQ/Xq0zgduSrRI/AAAAAAAAWyo/xjIUgX3aG94_6XFF3KjHxHY35qp0AI1iACLcBGAsYHQ/s320/child%2Bwith%2Bkwashiorkor.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Don't forget that malnutrition is a much bigger problem in the world than COVID-19</i></span></div>
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<a href="https://1.bp.blogspot.com/-yRR-3wWZ-0o/Xq0zklQHpiI/AAAAAAAAWzc/jbj7OtxXewkTue-wscqLq5PuNG_fTEnlQCLcBGAsYHQ/s1600/sickel%2Bcel%2Bgirl%2Bpink%2Bshirt.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-yRR-3wWZ-0o/Xq0zklQHpiI/AAAAAAAAWzc/jbj7OtxXewkTue-wscqLq5PuNG_fTEnlQCLcBGAsYHQ/s320/sickel%2Bcel%2Bgirl%2Bpink%2Bshirt.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>So many kids with sickle cell anemia, in pain, with infections, often doubly damaged by malaria too</i></span></div>
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<a href="https://1.bp.blogspot.com/--WNpzz4vjyk/Xq0zga4SqJI/AAAAAAAAWyk/mFL1b01e0dY2dR7Ko2lP_Q32YRM9-X0wwCLcBGAsYHQ/s1600/healed%2Bbaby%2Bwith%2Bbronchiolitis.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/--WNpzz4vjyk/Xq0zga4SqJI/AAAAAAAAWyk/mFL1b01e0dY2dR7Ko2lP_Q32YRM9-X0wwCLcBGAsYHQ/s320/healed%2Bbaby%2Bwith%2Bbronchiolitis.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Happy client, her 4 month old life nearly ended but now she's going home</i></span></div>
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<a href="https://1.bp.blogspot.com/-ksFuOBXriB0/Xq0ziDqUmMI/AAAAAAAAWy4/WRijnXYjLMUVJawcQztC-AyQCAs0jrkcwCLcBGAsYHQ/s1600/maternity%2Bstaff%2Bnicu%2Bmeeting.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-ksFuOBXriB0/Xq0ziDqUmMI/AAAAAAAAWy4/WRijnXYjLMUVJawcQztC-AyQCAs0jrkcwCLcBGAsYHQ/s320/maternity%2Bstaff%2Bnicu%2Bmeeting.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>This is a NOT SOCIALLY DISTANT staff meeting, but it did generate some good improvements in NICU care!</i></span></div>
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<a href="https://1.bp.blogspot.com/-eiQUx0lyj1Q/Xq0ziayRr3I/AAAAAAAAWy8/B3dL0CxPEuMkgDpYeUW1pxsosxCP7z3HQCLcBGAsYHQ/s1600/nurses%2Bin%2Broom.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-eiQUx0lyj1Q/Xq0ziayRr3I/AAAAAAAAWy8/B3dL0CxPEuMkgDpYeUW1pxsosxCP7z3HQCLcBGAsYHQ/s320/nurses%2Bin%2Broom.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Nursing station</i></span></div>
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<a href="https://1.bp.blogspot.com/-2PJHt0V3rAM/Xq0zi0t-JAI/AAAAAAAAWzA/Zfr8MXrMhe0SGWZuHMQiaPLGZccp5WVUgCLcBGAsYHQ/s1600/nutrition%2Bregister.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-2PJHt0V3rAM/Xq0zi0t-JAI/AAAAAAAAWzA/Zfr8MXrMhe0SGWZuHMQiaPLGZccp5WVUgCLcBGAsYHQ/s320/nutrition%2Bregister.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Admin is tedious, but it is necessary to track patients and justify receiving more nutritional supplements.</i></span></div>
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<a href="https://1.bp.blogspot.com/-swFH4GFhqTY/Xq0zizxjvlI/AAAAAAAAWzE/b8uNNsUP_CIJMF9_bVz-_PK9UHWDCs30ACLcBGAsYHQ/s1600/piper%2Bpuppby%2Btwo.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-swFH4GFhqTY/Xq0zizxjvlI/AAAAAAAAWzE/b8uNNsUP_CIJMF9_bVz-_PK9UHWDCs30ACLcBGAsYHQ/s320/piper%2Bpuppby%2Btwo.jpeg" width="240" /></a></div>
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<a href="https://1.bp.blogspot.com/-VmQpPwjteHg/Xq0zjXLg8eI/AAAAAAAAWzI/V8zaGdmZeecSPnbWCSVvq9jHzCgR0b7yACLcBGAsYHQ/s1600/piper%2Bpuppy%2B3.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-VmQpPwjteHg/Xq0zjXLg8eI/AAAAAAAAWzI/V8zaGdmZeecSPnbWCSVvq9jHzCgR0b7yACLcBGAsYHQ/s320/piper%2Bpuppy%2B3.jpeg" width="240" /></a></div>
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<a href="https://1.bp.blogspot.com/-BatPRO8vocs/Xq0zjgAE51I/AAAAAAAAWzM/SJOqj_XLM94bT-TGBNvbx5WsX70csqzsQCLcBGAsYHQ/s1600/piper%2Bpuppy%2Bone.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-BatPRO8vocs/Xq0zjgAE51I/AAAAAAAAWzM/SJOqj_XLM94bT-TGBNvbx5WsX70csqzsQCLcBGAsYHQ/s320/piper%2Bpuppy%2Bone.jpeg" width="240" /></a></div>
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<a href="https://1.bp.blogspot.com/-IFfTeQLNoEo/Xq0zmGrb69I/AAAAAAAAWzk/oEqEbDr3Hjsso8WrMJ_89hDUWTca7-dbgCLcBGAsYHQ/s1600/zane%2Band%2Bpuppy.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1018" data-original-width="1280" height="254" src="https://1.bp.blogspot.com/-IFfTeQLNoEo/Xq0zmGrb69I/AAAAAAAAWzk/oEqEbDr3Hjsso8WrMJ_89hDUWTca7-dbgCLcBGAsYHQ/s320/zane%2Band%2Bpuppy.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>Because rescuing puppies is always a good idea, even moreso in times of crisis.&nbsp;</i></span></div>
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<a href="https://1.bp.blogspot.com/-wxV7GqMcPwg/Xq0zkkhGzgI/AAAAAAAAWzU/WhvFP_8XLy4t_BQQoJQt68Cruql207SDgCLcBGAsYHQ/s1600/scott%2Bstarts%2BCS.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-wxV7GqMcPwg/Xq0zkkhGzgI/AAAAAAAAWzU/WhvFP_8XLy4t_BQQoJQt68Cruql207SDgCLcBGAsYHQ/s320/scott%2Bstarts%2BCS.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>Almost every day a life is saved when Scott, Isaiah, Marc, Ammon, Obwot do a C-section, often two, in this case four: Scott delivers triplets.&nbsp;</i></span></div>
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<a href="https://1.bp.blogspot.com/-dyLhNtJrlfM/Xq0zkh8Of7I/AAAAAAAAWzY/t_RI4YepBSssES8KfGT1BwdA3aRvoQZwACLcBGAsYHQ/s1600/triplets%2Bin%2Bincubator%2Bwith%2Bhats.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-dyLhNtJrlfM/Xq0zkh8Of7I/AAAAAAAAWzY/t_RI4YepBSssES8KfGT1BwdA3aRvoQZwACLcBGAsYHQ/s320/triplets%2Bin%2Bincubator%2Bwith%2Bhats.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>Triplet girls at 33 weeks. Names are Nyangoma, Nyakato, Kiiza. These are traditional names for "first-born girl twin, second-born girl twin, and the next sibling to come along after twins". Triplets that survive are rare, so most Kiiza's are a sibling a few years down the road, not a few seconds. Praying for these three, who would be our second set of surviving triplets in 2020.</i></span><span style="text-align: left;">&nbsp;</span></div>
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<a href="https://1.bp.blogspot.com/-jnbddItD7Uw/Xq0zlqytaBI/AAAAAAAAWzg/emVG_Rq_YSQEs7uwc2bxRzoXGyWB4-pywCLcBGAsYHQ/s1600/triplets%2Bside%2Bview.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-jnbddItD7Uw/Xq0zlqytaBI/AAAAAAAAWzg/emVG_Rq_YSQEs7uwc2bxRzoXGyWB4-pywCLcBGAsYHQ/s320/triplets%2Bside%2Bview.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>And our first set in the new NICU</i></span></div>
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<a href="https://1.bp.blogspot.com/-4wh_TwUKyDw/Xq0zhwMzJfI/AAAAAAAAWy0/CZesDQtcFgIxJ9Wagz0kYwYJ2_LuQm5wgCLcBGAsYHQ/s1600/mask%2Bface.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="962" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-4wh_TwUKyDw/Xq0zhwMzJfI/AAAAAAAAWy0/CZesDQtcFgIxJ9Wagz0kYwYJ2_LuQm5wgCLcBGAsYHQ/s320/mask%2Bface.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>you've heard of face-masks; this is mask-face (lines etched after a long day of continuous N-95)</i></span></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-21991056756819445392020-04-28T01:45:00.003-07:002020-04-28T01:45:44.159-07:00#COVID-19UGANDA day 39, Easter day 17: finding truth in a time of wilderness<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://1.bp.blogspot.com/-EFYmzypH50c/XqRo2wJOe9I/AAAAAAAAWxA/Vj2hMq0C92s9evhGhJlkBMitsgrKv1e5wCLcBGAsYHQ/s1600/22%2Bapril%2Bphoto%2Bwho%2Bwarning.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1072" data-original-width="1548" height="276" src="https://1.bp.blogspot.com/-EFYmzypH50c/XqRo2wJOe9I/AAAAAAAAWxA/Vj2hMq0C92s9evhGhJlkBMitsgrKv1e5wCLcBGAsYHQ/s400/22%2Bapril%2Bphoto%2Bwho%2Bwarning.png" width="400" /></a></div>
While this news article is enough to make anyone pause--large numbers, dire warnings--it was the <span style="font-size: large;">stock file photo</span> that caught my attention. <span style="font-size: large;">This looks like my mom and sister</span>. It is NOT, but it could be.<br />
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My sister had a birthday Sunday, and like all birthdays in this era, she cooked her own dinner and went on a socially spaced walk, while caring for her husband and son and receiving greetings by facetime. She's a hard-working woman who serves others. My mom, and Scott's mom, are troopers staying carefully low-profile, in their homes. For weeks. And more weeks. They are resilient octogenarians with a good grasp of science and a willingness to sacrifice. It's been a marathon and it's not over. One of our kids came home to police cars on the street; the next day the neighbors told him that one of their room-mates shot himself. The toll from the virus and from the fear and isolation is high in our country of origin. Much of America has experienced excess deaths from mid-March to mid-April, half known coronavirus and half unexplained (some actually are coronavirus but not known because of lack of testing and diagnosis or choice to remain home rather than be alone in a hospital, others are fear of accessing health care leading to late presentations of other common illness, dysfunction of parts of the overwhelmed health system, or coronavirus insidious effects that we have yet to delineate, or the mental health strain of a restricted existence, so many factors). A few areas have actually seen fewer deaths as roads emptied and crime plummeted. The models spoke of the hammer and the dance; we have been hammered with restrictions and they flattened even the steepest NYC curve. Now we are asking how to dance, how to ease up a little and see what happens. Cuomo today talked of cautiously opening valves and reading dials. Soon some places will relax restrictions, and then cautiously watch.<br />
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<span style="font-size: large;">The world hit 3 million diagnosed cases. Uganda hit 79. Tomorrow will be 40 days in the wilderness for us, longer for some others.</span><br />
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There is no way to know if opening the schools, or the restaurants, or manufacturing will do more good, or more harm. There is some evidence that the closures did some good. But the evidence is still to be gathered, the conclusions still to be drawn. <span style="font-size: large;">We're living in the middle of the largest scale experiment of our lifetimes, and we don't have the answers.&nbsp; </span>This is how science works. <b><i>We observe. We think and ask questions. We design ways to get answers by setting up intervention and control groups. We gather data. We analyse. It takes time. </i></b>There are truths that are given by God and handed to us by our traditions, of which we need to remind ourselves. My favorite this week was posted by Eric McLaughlin: " <i><b>The final secret, I think, is this: that the words "you shall love the Lord your God" become in the end less of a command than a promise.</b></i>&nbsp; - Frederick Buechner". I would add, love your neighbor as yourself to that. These truths remain a bedrock, and through this enforced time of restricted options, we are coming face to face with their necessity and comfort. And there are truths we have to discover like the relationship between force and velocity, or between virae and death.<br />
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So as I look at that picture and imagine my mom and my sister, separated by glass, wearing masks, wondering what is true, let's remind ourselves to rest on both kinds of truth. Base your actions on facts proven by peer-reviewed science. And base your actions on the truth that loving God and loving your neighbor are in the end what matters. Love requires sacrifice. My heart is pained by the fingers on the glass. But that picture of separation is not the end of the story. Here is one more quote from a Rohr meditation today:<br />
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<b><i>To heal from our suffering—not merely to ease or palliate it, but to transform it into the source and substance of our growth and wisdom—requires a journey through it.&nbsp;</i></b><br />
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Here we go, on towards day 40.</div>
DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-6170911830258551802020-04-25T02:07:00.000-07:002020-04-25T02:07:10.026-07:00#COVID-19UGANDA day 36, Easter day 14: When prosaic steadfastness becomes global poetry<div dir="ltr" style="text-align: left;" trbidi="on">
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Perks of being the last person to finish work: On Friday, the whole team ended up finishing ward rounds with me. We had to capture the moment because 4 doctors, a dietician, a nurse, and an assistant all in one spot represents such a significant percentage of active medical care in the district for a morning it was remarkable. In my defense, my first four patients of the morning were all ICU-eligible, only we don't have an ICU, we have three tables in the front of the room near the outlets for the oxygen concentrator and the window into the nursing station and with poles to hang blood transfusions. The first was actively convulsing from cerebral malaria. The second had a respiratory rate of 110. The third was a listless girl with sickle cell anemia unable to be transfused because the blood bank was out of her type. And the fourth was an infant with oxygen saturations ranging from the high 60's to the mid 80's as he struggled to breast feed.<br />
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<span style="font-size: x-small;"><i>Our "ICU"</i></span></div>
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<span style="font-size: x-small;"><i>New admission with malaria and decreased level of consciousness, quick check that she wasn't about to expire from anemia .</i></span></div>
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After that there were the usual kids draining pus and sweating fevers, dwindling with diarrhea, suspected of TB, with unexplained jaundice or persistent vomiting. Scott had planned to deliver triplets by C-section he discovered when doing an OB ultrasound this week, but that case had to be bumped back to Monday so the operating theatre could rescue a woman in urgent need of a C-section for obstructed labor, another with an ectopic (tubal) pregnancy, a man with a perforated bowel. Drs. Marc and Isaiah were introducing our new flow sheet for feeds and fluids and antibiotics in the NICU, and Jessie was weighing every patient and starting the most malnourished on supplemental milk or ground nut/soy paste.&nbsp;<br />
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Into all that mess, the prosaic and unremarkable work of steadfast, quotidian, routine care.&nbsp; Dextrose and diazepam and an LP, drawing blood for hemoglobins and crossmatching for transfusions, calculating feeds and fluids, instructing parents about what medications should be given at what time (nurses are overwhelmed, so parents have to initiate), reviewing wounds, changing dressings, doing ultrasounds, listening to hearts, checking pulses, probing abdomens, connecting oxygen, listening to concerns and giving reassurance. There is nothing very high tech or very remarkable in any of this. It is very basic medical care. We have no fancy monitoring systems, no ventilators, very limited drugs. <span style="font-size: large;">But we take what we have like the epitome-of-prosaic loaves and fishes, and hand it out.&nbsp;</span><br />
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Of course, <span style="font-size: large;">after prayer.</span> The morning staff meeting with our distance outdoors always ends with prayer.<br />
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Our kids sent me a link to a Peter Cottontale -Chance the Rapper song called "pray for real" that has stayed in my head. <i>I pray for vision, I pray for wisdom, I pray for weapons against the system, I pray for freedom to free the victims, to heal the brain, no pain inflict'em, I pray for real, I pray for real, I talk to God then wait for real, can't fake the fall, can't fake the feel, I pray for fun, I pray for real, I pray for ya'll . . . </i>Prayer is part of that prosaic steadfastness. After the staff meeting I always start rounds with prayer. I mostly say the same thing, every time. I ask God to come and heal the children because God can, and we cannot.</div>
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For five weeks and counting we have been living a severely restricted state, watching the world-wide pandemic escalate, reading all the news and medical literature with dread. But more and more, it seems that the basics are what we need. <span style="font-size: large;">Africa has much to offer the world on grit.</span> We can isolate, we can screen, we have brave ambulance drivers and medical officers, we can wear masks and wash our hands, we can be humanly present to comfort, we can try to keep up with oxygen and blood, we can trace contacts and make reports. We can develop a sense of shared community in the effort, we can put the present troubles into a bigger universe of spiritual perspective. We can determine not to neglect the real killers, malaria and TB and complicated labor, hypertension and diabetes. We can be mundane and plodding but still walk through the valley of the shadow of death.</div>
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<span style="font-size: x-small;"><i>This quiet nurse Amos fills out the discharge forms and gives pills and instructions to the parents every day, unglorious but essential work.</i></span></div>
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<span style="font-size: x-small;"><i>Olupah is our charge nurse, and she gets things done!</i></span></div>
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And down the road, CSB staff are working on our second packet of homework for students. With care to spacing, with obedience to limited transport, but with that same commitment to the small tasks that add up to service.&nbsp;</div>
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And our RMS teachers are in the final weeks of the year's curriculum. Moms still make meals, draw baths, monitor conflicts. Our accountant John is plugging away at his spread sheets. Josh got permission to begin essential work on the Nyahururu water project, at the epicenter of the December landslides, one of the systems that was completely destroyed. His truck of pipes was allowed to pass from Kampala yesterday, and today's he's up at the site directing the first steps after months of planning. Neighbors stop at the gate, sit on the porch, bring news that Bundibugyo's government salaries will not be paid in April affecting all the teachers, health workers, etc. Electricity is intermittent, lines being repaired. Uganda has two other plagues at the moment, a swarm of locusts larger than any in decades landing on crops in the north and east; and rampant water hyacinth islands blocking the Nile's power generating dam.&nbsp; Prices for cocoa, our main cash crop, have dropped. But we see lots of people with hoes and pangas, trooping off to gardens, and right now plot after plot with the early grassy green shoots of rice. Ramadan began yesterday, and even though curfew and COVID have stopped the blaring music at night we could hear our neighbors in their compound celebrating their iftar meal. Life going on, people adapting, and the heartbeat of all of that is the common daily inglorious work that is the core of what we do.</div>
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And perhaps by doing that, day after day, the prosaic takes the shape of the poetic. Psalms. Praying for real.&nbsp;</div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-1817630711548824352020-04-18T06:30:00.002-07:002020-04-18T06:30:55.511-07:00#COVID-19UGANDA day 29, Easter day 7: Do we want NORMAL?<div dir="ltr" style="text-align: left;" trbidi="on">
For the first few weeks of this pandemic, we were mostly just waiting for life to <span style="font-size: large;">get back to "normal"</span>. To be able to drive, to go further than a couple of miles from home, to hug neighbors and greet friends, to look forward to reunions and vacations and milestones. The pandemic pandemonium would, we thought, be a little blip on the ever-upward-trajectory of growth, and a shared milestone of some suffering that we could reminisce about for decades to come as we lived our old lives again.&nbsp; <span style="font-size: large;">It is now slowly dawning on us that there is no way back, only a way through, and we need to choose what the new normal will look like. And that for much of the world, the old-normal was not always appealing.</span><br />
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<a href="https://1.bp.blogspot.com/-fxw966gE1Ak/Xpr_VxWew7I/AAAAAAAAWn0/cy_YeCnODBo9lVF4xmSTU6fxz-Pp8aINQCLcBGAsYHQ/s1600/IMG_8810.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="300" src="https://1.bp.blogspot.com/-fxw966gE1Ak/Xpr_VxWew7I/AAAAAAAAWn0/cy_YeCnODBo9lVF4xmSTU6fxz-Pp8aINQCLcBGAsYHQ/s400/IMG_8810.jpeg" width="400" /></a></div>
In terms of the <span style="font-size: large;">origin</span> of the pandemic, do we want a world where intensive mass-scale animal agriculture leads to the kind of crowding and stress where pigs and poultry become the source of disease? Or where smaller farmers keep getting pushed to the periphery, where interaction with wildlife and the cross-over of pathogens becomes more and more likely? The evidence is mounting that COVID-19, like more virulent strains of Flu, or Ebola or AIDS or other diseases, are not random events. Their emergence can be <a href="https://www.theguardian.com/world/2020/mar/28/is-factory-farming-to-blame-for-coronavirus#maincontent">directly tied</a>&nbsp;to the choices we make about food, about consumption, about land. When those choices harm the majority-world poor but enrich the powerful, there is little public will to change them . . . but now that everyone is suddenly vulnerable, perhaps it is a good time to, in one of our favourite <a href="https://youtu.be/BFz78LAVE7k">movie phrase</a>s, "re-evaluate our decision-making paradigm".<br />
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<span style="font-size: x-small;"><i>Favuorites in one bowl, all local plant-based: g-nut sauce, gonja, beans, sombe, and rice.</i></span></div>
In terms of the <span style="font-size: large;">propagation</span>, is there any limit to the benefits of the transportation of humans from place to place? As a human whose life involves roots on two continents, that is a difficult question. But people like us brought this virus to almost every country in the world, in a very short time. Sitting in Africa, I can hardly blame people for questioning the justice of the very places that pillaged this continent's resources now turning their backs to us in a time of pandemic brought to us by them. And by them, I mean, me. Workers like us who decimated the Americas and Africa with smallpox. We didn't think it would happen again, but here it goes.<br />
In terms of the <span style="font-size: large;">response</span>, do we want to keep having a world where healthcare is a commodity that goes to the highest bidder? Where decisions about health rest in the hands of for-profit corporations? Has this pandemic led us to question the wisdom of assuming that our final metric is growth, consumption, spending, wealth? It has been interesting to see the world grapple with this, and there are no easy answers. Poverty kills. The coronavirus kills. Isolation measures have increased poverty and prevented coronavirus death. Which has been more significant? The jury is still out. Who should measure, who should decide? Has unbridled embrace of decentralisation and continuous mistrust of government been helpful? Or does this pandemic point out the need for coordinated action on behalf of the common good?<br />
In terms of the <span style="font-size: large;">impact</span>, we are already seeing the way underlying disparities affect outcomes. On an individual level, people of colour in the USA have had disproportionate mortality. On an international level, now Africa is <a href="https://www.bbc.com/news/world-africa-52323375">projected</a> to have as many as 300,000 deaths (we have usually 400,000 per year from malaria, so we still can't forget the big killers). 60% of urban dwellers live in unplanned settlements with poor access to clean water, and zero ability to isolate themselves. Rural populations represent the majority on the continent, and cannot work or study online without electricity and internet connections. Much press has gone to the number of ventilators or lack thereof, with the USA bemoaning only 1 for ever thousand or two thousand people .&nbsp; . . when Africa has one for every 200 thousand to 20 million people. Since up to 80% of the people put on ventilators even in high-resource places die, maybe we should focus on the basics. What if this shake-up allowed us to commit to clean water? To a strong public hospital system with good malaria care, with oxygen plants, with basic antibiotics, with safe deliveries?<br />
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<a href="https://1.bp.blogspot.com/-sy6SJ99BGUw/Xpr_TlpJhUI/AAAAAAAAWno/e3FeMyYCPaMHOEKvFoZhkHX2lopSuZ1NwCLcBGAsYHQ/s1600/IMG_8802.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="400" src="https://1.bp.blogspot.com/-sy6SJ99BGUw/Xpr_TlpJhUI/AAAAAAAAWno/e3FeMyYCPaMHOEKvFoZhkHX2lopSuZ1NwCLcBGAsYHQ/s400/IMG_8802.jpeg" width="300" /></a></div>
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<span style="font-size: x-small;"><i>why we need the basics--a totally fine recovery from malaria with deathly-levels of anemia</i></span></div>
And so as we pass the month-mark soon of COVID-19 in Uganda, that is what we are doing. Plugging along at justice. Encouraging our political leaders, speaking with our public health system, supporting our excellent medical superintendent. Augmenting oxygen. Doing one more ultrasound, one more C-section, one more infant resuscitation. Working our way through annual review meetings with our teams. Planning. Listening. Because the world needs faithful hard work, <a href="https://www.nytimes.com/2020/04/16/opinion/coronavirus-medical-training.html">tenacity and grit in</a> the face of suffering, people just doing their job over and over with kindness. That is how the Kingdom comes. And that's the new normal we hope to see.<br />
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<a href="https://1.bp.blogspot.com/-MThVZ5eraU0/Xpr_Z-cwioI/AAAAAAAAWoE/Wi6WO4ss0SMS6MNPwhvAnxRH1wjD5MAjgCLcBGAsYHQ/s1600/asita%2Band%2Bbuligi.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-MThVZ5eraU0/Xpr_Z-cwioI/AAAAAAAAWoE/Wi6WO4ss0SMS6MNPwhvAnxRH1wjD5MAjgCLcBGAsYHQ/s320/asita%2Band%2Bbuligi.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Two people with tenacity and grit, our friends at market.</i></span></div>
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<span style="font-size: x-small;"><i>And two more who once went to school with our kids and now are worried about their survival in the dangers of America--love to see the global leveling this time brings</i></span></div>
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<a href="https://1.bp.blogspot.com/-PctjokgwFWw/Xpr_SONMPKI/AAAAAAAAWng/ygBiIxdwp_0hvofcTlBhf9d-rfKmc90gACLcBGAsYHQ/s1600/IMG_8799.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-PctjokgwFWw/Xpr_SONMPKI/AAAAAAAAWng/ygBiIxdwp_0hvofcTlBhf9d-rfKmc90gACLcBGAsYHQ/s320/IMG_8799.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Trying to improve care for infants, don't let that one fancy incubator fool you, we have a LONG way to go</i></span></div>
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<span style="font-size: x-small;"><i>The most vulnerable, a malnourished toddler and her mentally-challenged pregnant mom</i></span></div>
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<span style="font-size: x-small;"><i>Linsdey prayed Thursday for relief from the heat, and we got quite a rainstorm that night. It probably dropped from 90 to 75 degrees on Friday morning, prompting this winter outfit.</i></span></div>
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<span style="font-size: x-small;"><i>As I was leaving Friday I found an escapee</i></span></div>
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<a href="https://1.bp.blogspot.com/-gzlMDQgoJds/Xpr_XRT-eNI/AAAAAAAAWn4/8Y-eN1SF73UwPIySdEsX-q6lP9GxcFaPwCLcBGAsYHQ/s1600/IMG_8815.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-gzlMDQgoJds/Xpr_XRT-eNI/AAAAAAAAWn4/8Y-eN1SF73UwPIySdEsX-q6lP9GxcFaPwCLcBGAsYHQ/s320/IMG_8815.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Confirming a healthy pregnancy in a young lady</i></span></div>
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<span style="font-size: x-small;"><i>Just walking into the next needful thing</i></span></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-83869746724979226642020-04-15T23:23:00.001-07:002020-04-18T02:59:40.122-07:00#COVID-19UGANDA Day 27, EASTER Day 5: the Paradox of the hidden sprout<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;">Easter is more than a day, it's a season, a resurrection way of life</span>. When I think of the open tomb, I imagine blinding light, angels, fireworks, glory. A dramatically visible moment of unmistakable turning, where everything starts to become new and true, the sadness undone. However, the only people who experienced it that way were the guards who went unconscious and were later easily bribed to change their story. So much for irrefutable drama. <b>The actual witnesses were women walking in the dark, going about their hands-on menial labor, puzzling over mystery, encountering a humble gardener one on one.&nbsp;</b><br />
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So we reach day 27 of living on a broken edge that got extra hard, and day 5 of living in the feast of celebrating how it's all transformed and healing and hopeful, and the <span style="font-size: large;">two don't seem to fit together very well.</span><br />
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<span style="font-size: x-small;"><i>Doreen, RIP</i></span></div>
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My sickest patient, Doreen, who just broke my heart with her starving little body, her too-soon-pregnant-again mom, the lethargic inability to turn the course of that dwindling life, died on Good Friday. I suppose the timing was a small gift from Jesus to bring meaning. Four children died the day before. Monday is a blur, Tuesday night two more died, and Wednesday morning as I was starting in the NICU I heard wailing from the Paeds ward and got a message that yet another had succumbed, a toddler who had not woken up from cerebral malaria we had been treating for days. This is the baseline reality of life here, <span style="font-size: large;">and without comprehensive ways to count and track, I can feel in my gut that there is some COVID effect but not really prove it.</span> At least four recent deaths were from respiratory infections--but that can be a thousand different viruses and bacteria, and since our first five tests (all negative) were taken to the national lab we've been told we don't have the proper swabs and can't test any more. Mostly our deaths are malaria, malnutrition, and sickle cell, and often all three. Or prematurity, neonatal infections, difficult oxygen-starved births. And when no one can move except on foot or by the limited ambulances, there is a curfew, people are terrified of getting the disease that is killing even rich well-resourced people, schools are closed so blood drives have faltered and life-saving transfusions are becoming harder to arrange, supplies have run out for key medicines, women in labor are stuck at home . . . we KNOW that our baseline struggles have only been augmented. (SIDE NOTE: Most years, over 400,000 people die of malaria in the world. So far, 137,000 have died of COVID-19 since December . . . which is a pretty similar monthly toll of 30-35,000.&nbsp; The difference is, for malaria it is 95% African children far from the cameras, and the rest of the world has no fear of the disease reaching them. And admittedly, malaria is treatable and stable and COVID-19 is still escalating and likely to exceed the average malaria toll soon.)<br />
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I want to walk into each day as if Jesus' tomb exit is still good news, and having impact. But then dozens of dysfunctions fly up in my face and there are jaundiced prematures not getting their feeds and fluids and lost lab results and confusing communication, and I quickly forget all about Easter. Where are the trumpets and power? <span style="font-size: large;">Why is it all so hidden and slow, so yeasty and sprouty when I feel we need miracles with exclamation points?</span><br />
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Easter to Pentecost, 50 days of a new world, <span style="font-size: large;">get very little print</span>. The arc of the spinning-into-decay universe changed to a direction of justice and wholeness, but <span style="font-size: large;">quietly.</span> Jesus walked around with his scars and cooked fish; he didn't bring an angel army to grab the throne and set everything in order. Like the proverbial seed that died, there was a sprout that one only sees by looking closely, moving some debris and dirt away, noticing.<br />
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At the beginning of Lent which feels like 6 years not 6 weeks ago, I was going to practice the discipline of noticing resurrection. Instead I found myself by yesterday just <span style="font-size: large;">spiralling into woe-watch, seeing the gaps and loss, and wanting the Jesus who throws the tables in the temple instead of the one that speaks peace to the hurting. I know I was not nice to be around. </span>And I suspect the pressure of most people's lives, unaccustomed patterns, extra work at home, uncertain endings or unattainable relief, the friction of continuous closeness, monotony, grief, have often led us to look for something proximate to lash out against (where is the nurse! why was the medicine not given!) in place of a vague cloud of pandemic and sorrow that we can't do a thing about.<br />
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<a href="https://1.bp.blogspot.com/-i-sGKlFl52U/Xpf3FybrrrI/AAAAAAAAWl4/2IvJdvMNxiwgXIBnmdjHiUZQRjq_zjXoACLcBGAsYHQ/s1600/masks%2Bwith%2Bkacie.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="962" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-i-sGKlFl52U/Xpf3FybrrrI/AAAAAAAAWl4/2IvJdvMNxiwgXIBnmdjHiUZQRjq_zjXoACLcBGAsYHQ/s320/masks%2Bwith%2Bkacie.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>me with Kacie heading to the last task</i></span></div>
My last task of the day was to find the Medical Superintendent to talk about our malaria medicine supply, as I had been buying stop-gap amounts of 10 vials here, 10 more there, over and over and we were completely out of it again. I was still in my table-turning mood, I admit. As Kacie and I walked towards his office, he was coming in another door with a few staff and a big smile. Before I could launch into my concerns, he told me, we just got 1,500 doses of artesunate from the National medical store! The chances of that intersection of need and supply and question and answer were so slim, I knew right away this was a glimpse of resurrection. A kind reminder from God that the seed is sprouting in hidden places, fragile shoots.<br />
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<span style="font-size: large;">So, go out looking for Easter, even though we're still living in lockdowns.</span> The week after the real resurrection, the Romans still ruled oppressively and the religious establishment still orchestrated a cover-up, the believers still hid in rented upper rooms, and even the chosen few still doubted. Don't look for fireworks, look for the tiniest green leaves. And pray for us to have eyes wide open, to look past the rising numbers (more than 15,000 COVID-19 cases now in Africa), the decision to cut off international funds like the WHO, the struggle to even treat relatively simple problems, and to have faith.<br />
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Here are some of the last few days of sightings:<br />
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<span style="font-size: x-small;"><i>Some functionality--our district has recognised the difficulty of getting patients to the hospital and now has an ambulance schedule!</i></span></div>
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<span style="font-size: x-small;"><i>Benjamin and Lindsey . . babies are always palpably places of hope</i></span></div>
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<span style="font-size: x-small;"><i>World Vision comes through with bleach and megaphones</i></span></div>
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<a href="https://1.bp.blogspot.com/-SlQBQfXsMs0/Xpf3Zw58sFI/AAAAAAAAWmQ/Ob4tQ0uxgMoEuj2A0kSQzlReqRcS3exVwCLcBGAsYHQ/s1600/easter%2Bflowers.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="1219" height="320" src="https://1.bp.blogspot.com/-SlQBQfXsMs0/Xpf3Zw58sFI/AAAAAAAAWmQ/Ob4tQ0uxgMoEuj2A0kSQzlReqRcS3exVwCLcBGAsYHQ/s320/easter%2Bflowers.jpeg" width="304" /></a></div>
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<span style="font-size: x-small;"><i>Flowers for Easter</i></span></div>
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<span style="font-size: x-small;"><i>Dressing up for Easter even with no where to go, a cheery Forrest Faith.</i></span></div>
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<a href="https://1.bp.blogspot.com/-c4otJhoMomM/Xpf3bAt4NpI/AAAAAAAAWmc/3wY1s91Q_GoHjfIgZN0IlUsk-Gkf-6-BACLcBGAsYHQ/s1600/full%2Bhall%2Bleading%2Bto%2Bward.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-c4otJhoMomM/Xpf3bAt4NpI/AAAAAAAAWmc/3wY1s91Q_GoHjfIgZN0IlUsk-Gkf-6-BACLcBGAsYHQ/s320/full%2Bhall%2Bleading%2Bto%2Bward.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>We still get plenty of patients coming . . . thankful for the nutrition team and the Paeds team!</i></span></div>
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<span style="font-size: x-small;"><i>Morning mercies, sunrise.</i></span></div>
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<span style="font-size: x-small;"><i>Dr. Isaiah puts up with my angst, and even helps moms learn Kangaroo care</i></span></div>
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<span style="font-size: x-small;"><i>This baby is my high point, we actually got an LP, a result, a diagnosis, a treatment, and we're half-way to healing from serious meningitis and healing. (Kenya friends, note the post-dehydration rash!)</i></span></div>
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<span style="font-size: x-small;"><i>Uganda is the blue line at the bottom, which is the hope that the isolation and contract tracing is working to at least delay the disaster . . .&nbsp;</i></span></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-22738926570071335042020-04-11T04:15:00.004-07:002020-04-12T05:26:09.643-07:00Day 22 in #COVID-19UGANDA; Holy Saturday in a Saturday World, preparing the spices<div dir="ltr" style="text-align: left;" trbidi="on">
We have now completed the equivalent of one full Ebola incubation . . . (21 days of health used to be pretty good news), with no clear end in sight because no one really knows the SARS-CoV-2 trajectory. <b>A 21 day slow-down, per Uganda and every public health expert one can listen to, has slowed the inexorable march of infection.&nbsp;</b> Not before a global 1.6 million infected and 100,000 dead, though.<br />
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<span style="font-size: x-small;"><i>The orange line is our flattened curve, bought at the cost of much hardship, but as our president keeps reminding us, this is not about convenience it is about the lives of Ugandans.</i></span></div>
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&nbsp;<span style="font-size: x-small;"><i>These maps of global flight patterns might explain our relative slowness to the COVID curve, even more than our strict social limitation measures. Turns out that China, Italy, and New York get a lot of movement. Africa, not so much.</i></span></div>
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Day 22 finds us beginning the next three weeks of constriction, of waiting, of uncertainty, <b>on Holy Saturday.</b><br />
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Two thousand years later, we sort of get the story. Looking back to yesterday's grief: the injustice and the pain and the darkened ending of a life, a hundred thousand times over, the replaying of the terror, the feel of the limpness of that body being carried away.&nbsp; And zero grasp of what tomorrow will bring. <span style="font-size: large;">It is Saturday, and we don't yet know if it's an Easter Saturday, the eve of resurrection, or just another long day post-loss and pre-glory</span>. We're caught in the midst of living the best we can with <a href="https://paradoxuganda.blogspot.com/2020/04/holy-week-and-covid-19uganda-day-20.html">no idea of just which story line</a>, the blue or the orange or one not imagined, we are on. Choices feel limited, and there is the numbing distraction of just how much energy it takes to do little more than be alive in 2020. Friday is behind us, we hope, so we should be productive. But on Saturday that feels impossible.<br />
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And it is not just our Saturday,<span style="font-size: large;"> it is a global Saturday, </span>where our small losses seem unimportant and hardly noticeable in the context of New York City, of Lombardy, of Wuhan. It is a Saturday where we wake up and think, well, we could have died Friday with Jesus, but we're still here when others are not. What now? We thought we were on the cusp of greatness, talking about left and right hand seating and thrones. Now our horizon has narrowed down to the aggressively needy beggars or the hot stretch of tarmac from home to a pile of tomatoes or basin of milk, our interactions have resolved themselves into minutes of 2x2 cm squares on a phone screen, our work has a feel of inevitability, more of the same malnutrition and pus and fever. Contraction, the stone of the grave or the belly of the whale, seems to be the Saturday reality. <span style="font-size: large;">No escape from the moment that is in itself, if we could see it, our escape.</span><br />
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How do we live in the reality of Saturday? The Saturday that has no certain 24-hour limit, that could be weeks, months, longer?<br />
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<span style="font-size: large;">Preparing our spices,</span> I suppose. The next necessary thing based on our Friday reality. That means we start with our daily routine. Psalms, every morning, preferably two. Coffee. Patterns where we can make them. Air. Work that depends on hope to have meaning, like planting seeds or feeding babies, work that projects forward, and especially work that is making meaning of the losses, like the preparation of those preserving fragrances to honour the dead. Art in general, and specifically Saturday art, that tells the story in the midpoint and doesn't insist on the conclusion. Dirty hands. Quiet. Space. Food. Lament. Pondering. Listening. Waiting.<br />
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Because Saturday is a day without answers, a day in-between, a day to let our narratives begin to shift. It wasn't supposed to be this way. We weren't supposed to be stuck here. To be separated. To be jobless. To be preparing burial spices instead of coronation clothes. We thought we were riding the wave and now it is breaking over us instead. We thought we were God's favourites and that meant things going our way, but now it looks like God's chosen loves still suffer, still lose control, <b>and that God suffers right there with them, and the happy endings take way longer than we expected.</b><br />
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<span style="font-size: x-small;"><i>Saturday road, in spite of constraints, people are out to buy and sell</i></span></div>
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<span style="font-size: x-small;"><i>Work goes on, slowly by slowly, a new boys' latrine at CSB, thanks to our friends who donated for infrastructure</i></span></div>
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<span style="font-size: x-small;"><i>Thankfully Ike likes to ride this old mission motorcycle and can ferry mail and a few groceries for team</i></span></div>
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<span style="font-size: x-small;"><i>Normally this space would be packed with dozens of boda taxis waiting for passengers. No longer legal.</i></span></div>
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<span style="font-size: x-small;"><i>We made the unleavened bread for our team on Thursday, even though we all ate the meal in our own homes post-curfew.</i></span></div>
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<span style="font-size: x-small;"><i>We did NOT get a lamb slaughtered here, but this butcher has bone-splitting panga moves.</i></span></div>
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<span style="font-size: x-small;"><i>Passover for three: Scott, me, and Elijah (he didn't show, again)</i></span></div>
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<span style="font-size: x-small;"><i>A 2020 twist, instead of foot-washing we passed the alcohol hand santiser</i></span></div>
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<span style="font-size: x-small;"><i>The screen shows a few of the about 25 families that shared the Messianic Passover Seder meal together via Zoom.&nbsp; Jason B dubbed it a Zeder.</i></span></div>
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<span style="font-size: x-small;"><i>If you could expand this photo you would see a family in our Area (the Robbins) celebrating passover with us by Zoom, Scott and I are on their screen.</i></span></div>
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<span style="font-size: x-small;"><i>Quiet road in front of the mission, only bodas with cargo, and people on foot.</i></span></div>
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<span style="font-size: x-small;"><i>Quiet school, waiting on this indefinite Saturday.</i></span></div>
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<span style="font-size: x-small;"><i>Sometimes a moment to bring meaning into the long days of uncertainty, like leading the kids through the Stations of the Cross on Good Friday.</i></span></div>
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<span style="font-size: x-small;"><i>Spice prep work: walking, dirt roads, gathering food, Saturday.</i></span></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-53453327069223816112020-04-08T23:54:00.004-07:002020-04-09T00:05:18.551-07:00Holy Week and #COVID-19UGANDA day 20; the Jerusalem path and the curfew meal<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;">Don't go to Jerusalem, they said.&nbsp;</span><br />
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<span style="font-size: x-small;"><i>Congolese cross art from my brief stop in Belgium last August</i></span></div>
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And with good reason, there was political unrest afoot, there was a rising cloud of tension and uncertainty, of threat or death. It was Passover time, a festival, a time of expectation, of crowds, of remembrance. Jesus who had remained relatively rural, mobile, difficult to trap, both gentle of touch and sharp of tongue, now spoke of impending death and walked directly towards it.<br />
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But first, a meal. A room, a limited gathering, a ritual connecting his small group of closest friends back to their history.&nbsp; Like their enslaved ancestors, they were living in a time of oppression and longing for deliverance. And like their enslaved ancestors, they did not quite grasp how it would come. What they did know was to go into their homes at dusk, to break unleavened bread and dip in wine and put the blood of their roasted lamb meal over their doorpost. To withdraw as the Angel of Death moved through, the tenth plague in a series of increasingly disruptive and dangerous difficulties.<br />
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In ancient Egypt, the curfew and isolation ended with an entire nation being born. In first-century Israel, the evening ended with arrest and tragedy and execution of the hope, and then unimaginable redemption.<br />
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I<span style="font-size: large;">n 2020, we are too close to see clearly.&nbsp;</span><br />
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<span style="font-size: large;">Get out of Africa,</span> seems to be the message we get daily from our embassies in various countries. Borders and airports are closed, yet every day or two there is yet one more email implying that perhaps a window will open. For some that needs to happen, for their own physical or mental survival. There is no one-size-fits-all path through this time, and anyone who thinks they can lay out a clear plan isn't reading Judges recently (where I happen to be). We all want to control God as being on our personal side. But if the stories tell us anything, it is that <span style="font-size: large;">God's rescues don't always look comfortable or predictable in real time</span>. Sometimes the army flees on its own, and sometimes the presumed victory does not materialise on time, and no one can say for sure which story we are in right now.<br />
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For the majority of our workers, we are here for the duration.<br />
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Partly that is like Jesus' path to Jerusalem, <span style="font-size: large;">we are just doing our job</span>, following our commitments and protocols, trying to be sensible and faithful. There is no safe place on the globe, and now we're more aware of that. If your path was towards Jerusalem, maybe it is best to keep following it. Pandemic or not, babies are still being born and some need a surgical escape route or a deliberate jump start to breathing. Malarial mosquitoes are still biting and someone needs to put in IV's and administer artesunate. TB still spreads insidiously until a canary-in-the-coal-mine toddler shows up with listless coughing and dwindling life, and needs a test and some medicine. Typhoid still punches holes in guts that need an emergency surgery. Hunger still stalks, and infants still need to be warmed and weighed and fed. Schools are closed but yesterday our staff at CSB still managed to finally get the home-work packets out to students, so they can work at home, no small task in a world without internet connectivity, without educational programs that can be decentralised. Some teams have been able to work with churches and groceries to provide food relief to the day-labourer majority of Africans who cannot stock up at Walmart and live off of a horde at home. Our Bible translators are working still, at home. Some are listening to neighbours share their anxiety, creating extra small jobs to help, or just giving help. Some are part of higher level planning in their area, purchasing equipment or doing training. Some are have taken in young singles stranded by the closed down public transport far from their homes. Some are praying.<br />
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<span style="font-size: x-small;"><i>One day we were resuscitating this infant with severe malaria and ICU-level vital signs, the next he was looking pretty normal</i></span></div>
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<span style="font-size: x-small;"><i>This is why we stay.</i></span></div>
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<span style="font-size: x-small;"><i>Just in time for the little girl in previous picture, Jessie got therapeutic milk delivered on her birthday.</i></span></div>
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<span style="font-size: x-small;"><i>Staff are still doing their job, babies still need their care</i></span></div>
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In the USA and Europe, the pandemic has strained places with 1 doctor per every several hundred people. We have one per several thousands, even ten thousands. In the USA and Europe, hundreds and thousand of ventilators per city seems sparse. On this continent, we're talking zero to 20's per country.<br />
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<span style="font-size: x-small;"><i>photos courtesy of acting head teacher, as staff prepare hundreds of packets, thousands of pages, to go out into a district where people don't have books and TVs and computers. Thankfully cargo is still legal.</i></span></div>
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We feel the cross, and on good days know it is just the light burden of a cross Jesus has already carried. <b>On other days, it feels weighty.</b> Our entire organisation was on a rare rhythm of simultaneity because our quadrennial all-continent meeting naturally meant that every single family planned travel, perhaps a vacation before or after, perhaps a Home assignment or a connection with friends or family. We were all headed for a break in a little over a month. Instead we are all pretty tightly restricted to a small, needy, unstable place watching not only our hoped-for rest disappear but our normally stressful lives might double, or triple, or more in sorrows. The kids on one of our teams listed their losses, an appropriate way for believers to be honest with God. Not being able to play football with a hundred kids is real. Not being able to see grandparents soon is real.<br />
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Will that cross mean any literal loss of life? We pray not. But even though none of us can ever be sure what the next day will require, in this particular moment of history the truth is more stark. <span style="font-size: large;">We believe we will be the ones in the house when the death passes over, unscathed. The odds are good for any one person that we will be. But small odds repeated hundreds, thousands, millions of times still add up to a pile of bodies.&nbsp;</span><br />
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We have been here before. When the ADF kept up their cross-border terror, we sometimes ran and sometimes stayed, we lived in that tension of not-knowing. When Ebola came to our district, it found us here and grounded us here, exposed, still working. Did we always make the right call? No. But when our partners speak of us, those are the two times that they perceived the love of God. <span style="font-size: large;">Solidarity in a shared danger.&nbsp;</span><br />
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<span style="font-size: large;">So day 20 of COVID-19 comes to us in Uganda, on the Thursday when we remember the passover meal.</span> 53 cases have been tested positive here, and all are alive still. Over 3 thousand travellers have been tested, and there are still 18 thousand that the Ministry of Health intends to track down. If 18 thousand people from high risk countries in March (mostly returning Ugandans) fanned out over the country, if 13 of our 53 cases were already community-transmitted, how can we escape? Yet all over the world we're seeing that the social-distance protocols are slowing the disaster, averting deaths, so we continue. Every few days our president holds night-time broadcasts to reminisce about his fighting days and enjoin the country to endure temporary inconvenience for long-term survival.<br />
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Tonight <b>at the 7pm curfew</b> we will celebrate Passover by Zoom around our area, remembering the truth on which our lives depend. <span style="font-size: large;">Jesus came among us as a human, lived through times as tumultuous as this one, faced the worst, and in his actual body absorbed all the hate and brokenness of the universe. His work constricted right down to a cave in the earth, a tomb. And then he reversed all the trajectory of sin and sorrow and injustice and loss, and walked out to lead us home.</span></div>
DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-11714956101587018722020-04-04T02:58:00.001-07:002020-04-04T02:58:46.024-07:00#COVID-19UGANDA day 14: collateral damage, collateral grace, deepened not diminished<div dir="ltr" style="text-align: left;" trbidi="on">
<b>This is how our days go</b>: pushing curfew limits for a bit of exercise in the morning, coffee, Bible, prayer, urgent texts and emails that accumulate from other time zones, perhaps a knock at the door, a question or crisis. Into the car by 8 for the 8 mile drive to the hospital, hoping not to be stopped by the police as we don't have a "COVID-19 MEDICAL" sticker yet, but we do have a written permission from our district government. The oddness of a staff meeting, standing 2m apart, outside, hearing the overnight report, the latest Ministry of Health directives. Rounds, patients, assessments, procedures, all while breathing through a mask in the 90+ degree heat of wards with little airflow, all while spritzing hand sanitiser liberally and having various staff all "borrow" mine as the level keeps dropping. Connecting here and there with Jessie, with Scott, with Marc, with Ammon, with Isaiah, as we discuss patients. Early afternoon at some point between 1pm and 3pm we finish and take our masks off at the car, carefully folding them into a cloth bag that I put on the super-hot dashboard to bake. More sanitising. Friday we walked another half-mile through town to the bank, as the local government had hinted darkly at confiscating our car . . . didn't want to risk any movement except home to hospital in a vehicle. Walking is pleasant, it slows the pace, makes you aware, makes you part of the community . . .but it does also add an hour here and there to a day of work. Back to our house by 3 for two hours of meeting with team mates about work, plans, future, coping. Walk to Nyahuka, our closer town (half mile?) to check on CSB staff with a sick kid, to buy milk. Stop back at mission house for another 45 minute meeting/check-in. Back through our gate before the dusk 7pm curfew. First chance to do dishes, to make dinner, to listen to news. Eat, connect with family in USA via texts or calls, answer emails, listen to our Ugandan President's long evening speeches, work at computer until 10 or 11. Sleep.<br />
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<span style="font-size: x-small;"><i>morning walk with mountains, thinking Psalm 121</i></span></div>
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<a href="https://1.bp.blogspot.com/-AsQsPdE9TGg/XohVt7jhuGI/AAAAAAAAWfs/dwO1Or8PbBAA7EH5_FKiuiFREfRwFCPSwCLcBGAsYHQ/s1600/staff%2Bmeeting%2Bfrom%2Bscott.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-AsQsPdE9TGg/XohVt7jhuGI/AAAAAAAAWfs/dwO1Or8PbBAA7EH5_FKiuiFREfRwFCPSwCLcBGAsYHQ/s320/staff%2Bmeeting%2Bfrom%2Bscott.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>a few views of morning staff meetings with #social_spacing</i></span></div>
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<a href="https://1.bp.blogspot.com/-RFzJKvtIJ9E/XohVp3TgqRI/AAAAAAAAWe4/liTT274NzY4VuJnhctnRK_zyT786CyLxQCLcBGAsYHQ/s1600/cleaners%2Boutside%2Blab.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-RFzJKvtIJ9E/XohVp3TgqRI/AAAAAAAAWe4/liTT274NzY4VuJnhctnRK_zyT786CyLxQCLcBGAsYHQ/s320/cleaners%2Boutside%2Blab.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>the unsung heroes of COVID, the cleaning staff</i></span></div>
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<a href="https://1.bp.blogspot.com/-thUDJh1rtz8/XohVrLxGpkI/AAAAAAAAWfM/TbRZd9FnKFwGSsTr4UyfshPJquLM2sPLACLcBGAsYHQ/s1600/hospital%2Boutside%2Bcorridor.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1215" data-original-width="1280" height="303" src="https://1.bp.blogspot.com/-thUDJh1rtz8/XohVrLxGpkI/AAAAAAAAWfM/TbRZd9FnKFwGSsTr4UyfshPJquLM2sPLACLcBGAsYHQ/s320/hospital%2Boutside%2Bcorridor.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>the corridors between hospital wards</i></span></div>
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<span style="font-size: x-small;"><i>children are still malnourished no matter what the world is wobbling about; Jessie doing weights</i></span></div>
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<span style="font-size: x-small;"><i>a very sick baby, I did an LP, and actually got gram stain results. Not good news but at least we know what we're dealing with.</i></span></div>
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<a href="https://1.bp.blogspot.com/-8fCgMUuacTo/XohVs1KoyQI/AAAAAAAAWfg/ggjQJsYW94Igu9HgJJJZ3McxoPDg8lshwCLcBGAsYHQ/s1600/patient%2Bon%2Brounds.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-8fCgMUuacTo/XohVs1KoyQI/AAAAAAAAWfg/ggjQJsYW94Igu9HgJJJZ3McxoPDg8lshwCLcBGAsYHQ/s320/patient%2Bon%2Brounds.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>TB treatment, malaria treatment, malnutrition treatment, transfusions . . . must go on!</i></span></div>
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<span style="font-size: x-small;"><i>(pc Marc) a sweet moment Friday, Baby Flavia the 800 gram preem whose mom died late 2019 is now a fat and happy thriving 4 month old!!! thanks for prayers.&nbsp;</i></span></div>
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<span style="font-size: x-small;"><i>Scott is happy to be back in the surgical theatre</i></span></div>
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<span style="font-size: x-small;"><i>discussing a difficult case with Dr. Ammon and Dr. Marc, thankful for colleagues</i></span></div>
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<span style="font-size: x-small;"><i>For my kids, a Man U fan dad and his kid named Rashford . . .&nbsp;</i></span></div>
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<span style="font-size: x-small;"><i>post work walking through Bundi town to bank, living proof of presence</i></span></div>
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<span style="font-size: x-small;"><i>the bank is enforcing #social_spacing</i></span></div>
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<span style="text-align: left;">&nbsp;</span><a href="https://1.bp.blogspot.com/-9UGNnB5Dp34/XohVrrcomxI/AAAAAAAAWfQ/1HIxirLdTikEUqUr9k76zoQNT4iIEHvxQCLcBGAsYHQ/s1600/market%2Bwalk.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-9UGNnB5Dp34/XohVrrcomxI/AAAAAAAAWfQ/1HIxirLdTikEUqUr9k76zoQNT4iIEHvxQCLcBGAsYHQ/s320/market%2Bwalk.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>stop in the market for passion fruit; we are still allowed to buy and sell food</i></span></div>
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<span style="font-size: x-small;"><i>waiting for the evening briefing</i></span></div>
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<i style="font-size: small;">living in the reality of hanging on the words and desires of the leader</i></div>
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So at this point we aren't doing virtual museum tours or scouring for great podcasts, we barely have time to manage life.<br />
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Today I'm thinking a lot about <span style="font-size: large;">the collateral damage of COVID</span>. Only 48 cases in Uganda, and the zeal with which this country is tracing contacts and enforcing social space is pretty impressive. Because we are remote and poor, our exposure has been later and more limited. But that does not mean we are not impacted. In the 14 days since COVID came and restrictions ramped up, Scott has had four pregnant women with a ruptured uterus come to the hospital. It used to be 1/month was remarkably bad, now 2/week is a new normal. If you go into labor and things go bad, and you can't manage to get to help because there is no transportation, there is curfew, you're afraid, the health system is stressed . . . then the contractions lead to catastrophe, a dead baby, a dying mother. Friday he and Dr. Ammon spent the entire morning in the operating theatre with two complicated cases like this. We can't see most of the collateral damage, the malaria that kills at home, the sickle cell kid that doesn't get transfused in time. But once our first suspect cases tested negative, the Paeds ward started filling back up. We have a child who had surgery for hydrocephalus at a specialized hospital on the other side of the country, and now is experiencing re-accumulation of the fluid in her brain, but can't get back. <span style="font-size: large;">Collateral damage abounds.</span><br />
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And there is <span style="font-size: large;">more subtle</span> collateral damage. The many people, especially men here (since women are still doing their unending labor of child care and garden work and cooking and washing) whose ability to earn, to provide, has been suspended. The impotence of that, the frustration, the unknowing, the fear. This hurts. The only mobile people now are the 17-30 year old males who can drive motorcycles. OK there are a few trucks moving goods too. But mostly women have been relegated to foot. This is a collateral message: women stay put, men can move. We saw a CSB teacher teaching a woman to ride a motorcycle yesterday, and that was a little piece of rare empowerment. Then there is the long-standing pain of turning human contact from a basic need to a potential fatality. All cultures need touch, need face to face communication, need gathering. <span style="font-size: large;">How will we emerge on the other side?&nbsp;</span><br />
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<span style="font-size: large;">Where there is collateral damage, there will be collateral grace.</span>&nbsp;That is the basic premise of the universe founded on love: God is at work to bring the fruit from the seed that dies, to bring joy from the tears that fall, and nothing can stop that. In March I happened to pick up Eugene Peterson's <b><i>Under the Unpredictable Plant,</i></b> a book about the prophet Jonah that had been impactful for us when we lived in Uganda before and still remained from our library. He talks about the contraction of Jonah's world into the belly of the fish, and how God often <span style="font-size: large;">uses times of imprisonment, constriction, loss of freedom, for the greatest spiritual work.</span> I think we are being globally disabused of our approach to spirituality as consumers who shop for the latest self-help.<br />
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<i>We begin by insisting that askesis (</i>his word for the constricted life)&nbsp;<i>is not a spiritual technology at our beck and call but is rather immersion in an environment in which our capacities are reduced to nothing or nearly nothing and we <span style="font-size: large;">are at the mercy of God to shape his will in us.</span> . . Suddenly instead of mindlessly and compulsively pursuing an abstraction--success, or money, or happiness--the person is reduced to what is actually there, to the immediately personal--family, geography, body--and begins to live freshly in love and appreciation. The change is a direct consequence of a forced realisation of human limits. Pulled out of the fantasy of a god condition and confined to the reality of the human condition, the person is <span style="font-size: large;">surprised to be living not a diminished life but a deepened life</span>, not a crippled life but a zestful life. God-intensity begins to replace self-absorption; mature wisdom begins to supplant self-importance.</i><br />
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What if that is our global path in 2020? Facing our limits (YES we are doing that!) and finding depth, mercy, grace, goodness and love. We have a long way to go, but holding lament in one hand for all our sorrowful loss and hope in the other for God's love to still abound, is the only way forward.<br />
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<span style="font-size: x-small;"><i>empty CSB . . . our staff are still on site, some minor construction projects are ongoing, firewood procurement in hopes of students ever returning . . . we try to visit and encourage our friends with waves from a safe space distance</i></span></div>
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<span style="font-size: x-small;"><i>Saturday morning cappuccinos&nbsp;to lift spirits, also outdoors and #social_space</i></span></div>
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<span style="font-size: x-small;"><i>the little face we see in our door as we return home</i></span></div>
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<span style="font-size: x-small;"><i>trying to comply with science and with policy, a team meeting on our compound, outdoors and spaced</i></span></div>
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<span style="font-size: x-small;"><i>the rules</i></span></div>
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<span style="font-size: x-small;"><i>Rumors went out that we were all leaving on a helicopter yesterday; we walked through town to show we were still in the fight.</i></span></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com2tag:blogger.com,1999:blog-8176735909708151146.post-8180316797192364452020-04-02T11:26:00.003-07:002020-04-02T11:26:55.953-07:00#COVID-19UGANDA day 12: Ways in which this pandemic makes our life and yours similar, and ways in which we feel the burden is heavy<div dir="ltr" style="text-align: left;" trbidi="on">
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Some ways in which YOUR life in COVID-19 (since it was announced on the very last day of 2019 it got the 19 designation, but this seems a bit unfair to 2020, which is bearing the brunt of this virus) is <span style="font-size: large;">similar to our life every year,</span> or ways in which we are probably more equipped to live in quarantine:<br />
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<li>We already<b> talk to our parents and children by internet-based protocols.</b> Group FaceTime is our go-to. We use What's App groups for much of our work communication, emails, zoom calls, virtual conferencing. So even though we are remote and have not always had phones or internet signals, we had a decade jump on the work-from-home digital life and the no-chance-of-human-interaction personal life. #social_space is how we live globally.</li>
<li>We already <b>shop in weeks-to-months increments</b>, we already live off of dried beans and rice and pasta and canned goods much of the time, we already do without access to ice cream or restaurants or movie theatres. We come back from trips to Kampala with boxes of oil and bags of sugar, with tomato paste and crackers and other things hard to buy locally, every couple of months. We have been rinsing our local fresh vegetables in a very dilute bleach for two and a half decades. We already plant gardens.</li>
<li>We know that electricity and postal service and running water and mechanical help and fuel and the general network of societal <b>infrastructure is tenuous</b>. Yesterday the power was out for almost 24 hours. We already have a couple of solar panels and a small generator. We collect rain water. We can walk to food shops. Africa is generally going to prove resilient I think.</li>
<li><b>We already have to ration</b>, make do, make choices. We already know that we can't save everyone, that death is real and present. I'm not saying that's good or right, but yesterday I had two infants who both needed one oxygen tank. The first one's mom had been in a long hard labor, and the baby had not been realised to be in distress from a cord around the neck. Scott walked into maternity to find the baby looking rather dead on delivery, and called me and we both worked to resuscitate the very asphyxiated baby, which was successful, but he needed oxygen. Then a few hours later a mother come with a 17-day old baby that looked like he was in septic shock. As Dr. Isaiah and I worked to get diagnosis and treatment, I checked the oxygen levels, very low. So I moved the single available source to the 17 day old, then checked the first baby. Uh oh. That one had dropped back to danger again off oxygen. Frankly I felt the newborn had a better chance of survival, but I was trying to make phone calls, find the right person with the key or the wrench or the capacity to hook both of them up, when one of the nurses said, "I have the key to the NICU where there is another tank .. ."&nbsp; So we could help both in that moment, but the point is, this kind of triage is constant.</li>
<li>We already can't go where we want or do what we want a lot of the time. <b>We live constricted lives in some ways, with limited choice, small ranges.</b></li>
<li>And lastly, when the world constricts, <b>we do have community</b>. We live very close to each other. We have outdoor space, and we live mostly on one big connected compound, so for the last two weeks our team has still been able to interact with our 2m distancing. We have sunshine, and views of the mountains, and birds. I think our space at home is nicer than much of the world's.&nbsp;</li>
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But here are some ways that <span style="font-size: large;">we are still finding this COVID-19AFRICA a weight.</span></div>
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<li>When our country does "stay-at-home", it means <b>NO DRIVING AT ALL</b>. We are expected to go to our gardens, to the market, to the bank, ON FOOT, and no crowds. This was instituted on Monday night, and Tuesday we were able to get an exemption for a few of us to travel TO THE HOSPITAL (12 km/8 miles so a bit of a long walk) only.&nbsp; I think this has been one of the hardest adjustments for all of us.</li>
<li>Our rules are <b>enforced by police with "canes"</b>. They walk around with sticks and regularly beat people who do not comply, so people are afraid. We also have armed military supervising the curfew. If you are out in the dark (7p to 6:30am) you are at risk of being harmed.</li>
<li>We have <b>no real emergency room to go to, no ICU to back us up</b>. This may be more of a psychological than real loss, since ICU survival for this virus is quite low. Still it is sobering (our new most over-used word, but hey, it IS sobering) to know that if we need anything more than a very limited amount of oxygen, God alone can save us. That is always true, but rarely felt. Now it is quite real.</li>
<li>We have <b>no escape valve, no plan B</b> that is sure, as we said above for medical but also for any political upheaval. With closed borders and zero flights, we are where we are.</li>
<li>We are surrounded by <b>people who have even less</b> options than we do.</li>
<li>We are surrounded by <b>people for whom we have historically been a bit of a safety net</b>, people whom we offer employment or education or health care or water. In this culture, we look to each other when times get tough, and we feel the weight of neighbours who have, and who will, look to us. How long can we keep paying salaries if our schools remain closed and no parents can pay school fees?&nbsp;</li>
<li>Our rules are set <b>by a single person</b> with extensive powers, which in this global crisis will probably turn out to be good on a utilitarian scale of preventing illness and death, but still feels uncomfortably random at times as the implications of decisions are not always clear. Perhaps because of the no-go rules, we are experiencing the reality more than usual.</li>
<li>When our hospital staff meets daily in the morning, we aren't discussing how many ventilators to buy, or when the thousands of new PPE's will arrive, or how many of the hundreds of new doctors and nurses will be hired. We are discussing, literally, whether police or doctors should chase out people who come in to sleep on the benches in the outpatient department at night, or the family members who sleep under beds who should be limited to one and not two. We are discussing whether sweeping the dirt driveway is aerosolising virus. We are discussing that on the night shift, the maternity <b>nurse had no gloves,</b> no pitocin (crucial medicine to stop bleeding). We are discussing whether malaria medications can be re-assigned from other small health units because we are out. We are discussing the difficulty of patients getting to and from the hospital because of the total ban on motorised transport. We are discussing how long suture supplies will last, or blood in the blood bank. This is a <b>fragile system</b> that teeters on based on the hard dedicated work of some brave people who aren't afraid to get messy, to improvise, to risk. But it is so marginal.</li>
<li>I think everyone at this point is <b>uncertain</b> about what the next few weeks or months will bring, but for us there is an added layer of not just, how bad will the medical and economic impacts be, but how long can we hold on if our connections to our supporters dwindle, if something happens to family far away, if we personally become very sick, if the world order changes, if there is political fallout.</li>
<li>And related to the above, the <b>mixed messages and second-guessing</b> just wear us out. Travel is dangerous, and spreads the disease. Everyone should stay in place. The US told citizens living abroad to stay where they were. But then our embassy keeps sending emails to say, there might be one more flight, there might be an option to leave, register your interest if you want to go. These long-shot chances being thrown out over and over are wearing.</li>
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And here is a last vignette that talks about the <span style="font-size: large;">way we are always sticking out, and possibly that is good.</span></div>
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<li>We cannot blend in. In a district of 250,000 people, the only non-African-appearing humans are our team of 15 kids and 14 adults. Everyone knows what we do, where we go. And in this moment, we look like the humans from countries where coronavirus is skyrocketing. In some places that can be dangerous. So Scott asked a friend yesterday, whether he thinks people are worried about us walking down the road to the market. Should we send someone to get us food so we don't worry people? The friend replied, "Oh, doctor, you are wrong about why people stare. They are not worried. They comforted. They are glad you have not left. Please walk down the road!" So that was encouraging.&nbsp;</li>
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Uganda is holding at 44 cases, still mostly from returning Ugandans (42) who were in Dubai, or UK, or USA, plus a couple of Chinese nationals. Kenya has accelerated to 110 cases and 3 deaths. DRC, 123 cases and 11 deaths. Rwanda, Burundi, 3 cases, Malawi, zero. 180 countries, almost every country in the world is now affected. Spain, Italy, and New York state are bearing the brunt of it right now.&nbsp;</div>
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The photo at the top is a rainbow that prepared us for the stricter limitations on our movements this week. We are not going to get this thing completely right. We are going to make mistakes. We are in for some hard days. We are already experiencing grief on many levels. <span style="font-size: large;">But God has not left us alone, God will not let this virus destroy us.&nbsp;</span></div>
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Our team continues to move through Eric McLaughlin's excellent book,<a href="https://newgrowthpress.com/promises-in-the-dark-walking-with-those-in-need-without-losing-heart/"> Promises in the Dark</a>. Each week seems to find us exactly where we are in our struggle. This week we looked at the idea of mystery. We believe many things about God, and in fact we know God relationally as loving and trustworthy. But then we look at what we can see in this world, and is a huge tension between what we believe and what we see. We can resolve that gap with denial of what we see, or despair about what we believe. OR WE CAN RESPOND WITH DEFIANCE. Eric's choice of that word intrigued me and led us to Job. If any character in the Bible models how to live in that gap between what we believe and see, it is Job, who constantly takes his grief right to God. He struggles. He engages. He asks.&nbsp; He laments. He defies the people who try to wrap up explanations in neat boxes, and instead chooses the greatest statement of faith: though he slay me, yet I will trust him (13:15). Job has the nuance of mystery, the avoidance of easy answers, and the defiant will to hold onto the one who holds on to us. Here is how Eric ends the chapter, and how we will close for tonight:</div>
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<i><b>"Trust can persevere in the face of mystery because of a hope in a story bigger than what's visible, and because of the continued trustworthiness of God who's shaping the story."</b></i></div>
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COVID-19 has taken the story of 2020 on unprecedented paths, but we trust God's bigger story to bring a redemptive good that is bigger than what we see on our graphs.</div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-78941247961948338532020-03-29T07:47:00.002-07:002020-03-29T07:47:34.557-07:00#COVID-19UGANDA day 8; on Fear and Charms and Ultimate questions<div dir="ltr" style="text-align: left;" trbidi="on">
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You know the "pan" is in pandemic when you find a diagram of the coronavirus on the wall of a home in Bundibugyo. I was intrigued by the personification of those eyes; the medical detail of the protein spikes; the smear of mud on mud to make it adhere.</div>
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The first sign made me assume that someone was doing a little teaching. The second and then the third made me curious.<br />
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Adherent to the front of the house, some kind of tag, warning, or an attempt to ward off the evil? I asked a lady I recognized who was greeting us, and she ran around the corner of her house and ripped the paper down, muttering something about the children, then turned to us and affirmed "Ruhanga enka."&nbsp; Only God.&nbsp;</div>
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We are all in this same boat. In Iran, we read today, a viral meme about whiskey-and-lemon as a cure for the common cold plus the confusing insistence on high-potency alcohol hand gel, in a country where alcoholic drinks are forbidden, has led to hundreds of people sickened and even dying from the ingestion of toxic industrial methanol.&nbsp; The CDC had to warn Americans against purchasing an additive meant for fish in aquaria that contained chloroquine in the ingredient list, after reports emerged of toxic ingestions to ward off corona. <span style="font-size: large;">We all want a way to feel safer. </span>For many of us that's information. Reading the literature, checking the stats, examining who died and who did not, clinging to the reasons to assume ourselves into that 85% camp with an almost-assured recovery. For others the fear stokes latent anti-other feelings. Some African communities are threatening to harm anyone from other places, and we don't exactly blend in well. Some American states don't want anyone with out-of-state tags passing through. Yes we should respect the basics of hygiene and socially responsible (read, LIMITED), movement. Yes, we should embrace this season of the hibernation, the limit, the small. It is however heartbreaking to see the way that crisis reveals not only hidden generosity and goodness, but also darker realities.</div>
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<a href="https://1.bp.blogspot.com/-9Kj4glajIWY/XoCqDbpRTiI/AAAAAAAAWdo/VHtkFzIxyeETOBdqXzBgcoDYDh0KxZ_WwCLcBGAsYHQ/s1600/river%2Bvalley%2Bview.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-9Kj4glajIWY/XoCqDbpRTiI/AAAAAAAAWdo/VHtkFzIxyeETOBdqXzBgcoDYDh0KxZ_WwCLcBGAsYHQ/s320/river%2Bvalley%2Bview.jpeg" width="320" /></a></div>
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But here on the edges, I can see the appeal of the evil-repelling charm, the bet-hedging poster. No one in this district is going to be on a ventilator, so if Africa follows trends of the North we could be looking at death we are helpless to prevent. Face to face with such realities, our neighbours aren't stockpiling toilet paper or calling 911. <b>They are going down to the spiritual questions which matter. </b>There is a new harm afoot, and how can we survive it. These are the questions that have faced humanity for millennia, though we do our best to numb them. Is God good? Does God care? And can that truth, if held, encompass the reality of COVID-19, or AIDS, or malaria, or war, or poverty, or corruption, or, or, or.. . . .?<br />
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Uganda's cases now number 30; all our neighbouring countries have slowly accumulating counts as well, except for a couple that are either very isolated or very reluctant to test or most likely, both, with zero. The five suspect cases from our hospital on Friday were all tested negative by Saturday night. So we still find ourselves in the peculiar position of brace. Of watching our families in the USA and UK become more and more hemmed in, surrounded. Of some of our kids working long hours in the hospital or garden; of other family members spending their days to protect the vulnerable by keeping our older or immune-challenged people set apart. While we wait for our environment to become like theirs, only without 90% of the response capacity.<br />
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In similar times, people of faith looked to the hills and asked, where does help arise?&nbsp; And I think my neighbour already gave us the answer. Ruhanga enka. The maker of all things who never sleeps. Let's wash hands, and use every spark of wisdom to research better care, every spark of compassion and energy to save lives. Let's use all that God has given us to fight against not just this virus, but also fear and hate. But for now at least we have to do that <span style="font-size: large;">while living in the tension that we can't control the story, but we know the one who is writing it can bring good yet.&nbsp;</span><br />
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And while you're at it, remember the Psalms (like 121 above). <a href="https://youtu.be/XVZO4sHxnvQ">This song</a> echoes 126 (and Rev 21). I also keep going back to <a href="https://youtu.be/H7pJb49vVQY">46 and 23</a> and 27. And <a href="https://youtu.be/1m_sWJQm2fs">42 with echoes of Jonah</a>. Or Psalm 91. Post your favourite Psalms and songs for this time.<br />
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com2tag:blogger.com,1999:blog-8176735909708151146.post-10844077934101342442020-03-28T05:55:00.000-07:002020-03-28T05:55:16.414-07:00#COVID-19UGANDA; end of week one, the paradox of weeping and truth<div dir="ltr" style="text-align: left;" trbidi="on">
It is Saturday, and the weaver birds quarrel and chatter as they bustle about their nest colony in the royal palms outside the front door. Scott is sitting outside on our patio with a policeman. <span style="font-size: large;">Because even though we don't have COVID-19 death yet, we still have death. </span>We are not yet on lockdown here in Uganda, though now the <b><span style="font-size: large;">country reports 23 cases</span></b>. No public transport, even motorcycle taxis (bodas) are not allowed to carry a passenger, no school, no churches, no gatherings, no weddings, no funerals except 10 immediate family . . . but people can move to the market on foot for food, can greet each other with a wave and conversation. So we are still meeting as a team, with some small attempt at #social_space but a bit of inevitability too. Mostly we are a lower risk group, and the harm of complete isolation in a culture far from home at a time of world upheaval has seemed more risky than sitting in a circle to study the Bible and pray. So on Thursday afternoon, we had our usual team meeting followed by outdoor pizza making.&nbsp; As we were putting pizzas into the oven and gathering team, we heard a massive shattering crash sound. Twice this week major branches have fallen from our mango tree (it's an old tree, this is a fruitful season, and as the rains return there is wind). So I immediately checked to see if a kid had climbed and fallen, or been smooshed. But Scott and Marc realized it was an accident on the road and went running out the gate. I was a few feet behind after stopping inside to grab some gloves.<br />
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<span style="font-size: x-small;"><i>All screening to take place in that tent before entering Outpatient Department</i></span></div>
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There was a motorcycle on its side, and many yards up the road, a young man lying on his back with a gathering group of onlookers. We checked his body, held his head to protect his spine, cleared his airway (thanks Kacie for running home to get a bulb sucker), protected him from being moved, assessed his neurologic status (NOT GOOD) while Marc cajoled the hospital ambulance driver into coming. There was blood, there was the eventual arrival of someone who knew his name, someone who could call for family, a wailing young wife, the police. There was the depressing reality of a hole in the back of his skull, and almost certain dangerous bleeding in his brain. There was a moment of prayer by our friend Asita who came by and we invited to intercede, loudly on her knees by the roadside, followed by a bit of hope when he seemed to start responding to us slightly. We eventually got him onto the guerney with his spine still protected, and off to the hospital. He died an hour later.<br />
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<span style="font-size: large;">Nothing to do with the pandemic, but everything to do with the edginess of life here, </span>being first responders to a motor vehicle fatality right smack in front of our house at a time when we are already on high alert and deep in grief. Seeing again the inadequacy of the health system.<br />
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<span style="font-size: x-small;"><i>staff meeting with #social_spacing</i></span></div>
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Friday morning, our hospital staff meeting was held outside, with us standing several feet apart, for better following of protocol. Two suspect patients had been admitted to the Ebola Treatment Unit, a tent set up 18 months ago in response to the Ebola epidemic boiling away less than 50 miles west of us. That had lead to general exodus. Maternity and Paeds still had half to two-thirds of beds full, but since we usually have ALL and many on the floor, it felt quite empty. I did a talk with all the patients to keep giving as accurate information as we can, to fight fear. Two young babies had lung findings and respiratory rates over 70. It is impossible to say if that is a coronavirus or some other virus. I was thankful for my mask.<br />
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And again, in the midst of all that, death came stealing. A newborn delivered at a smaller unit that morning, after 2 days of labor, limp and blue six hours later but still with a detectable heart rate. His young mom, first baby, laid him down wrapped up in the kitengi, hoping for a miracle. Scott called me to help and we did CPR together. No oxygen (!) but just bagging his little lungs and pushing his heart inside his little chest and a shot of dextrose and epinephrine got him pink and his heart back to normal. But his little brain was just as damaged as the motorcyclists I'm afraid. He was still alive on CPAP in our new NICU as I left, but taking infrequent gasping breaths. In both situations, almost no hope of recovery, but a kindness to still do SOMETHING, to put our hands on and give what care we can and minister the peace that the family did all they could.<br />
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<i><span style="font-size: x-small;">Jessie and Kacie, nutrition program still goes on</span></i></div>
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Processing life during this pandemic is a constant, exhausting challenge. With our team, we agonize over policies. We delve into scriptures about prayer. We lament losses. We share where we are, knowing the next hour could bring a new level of restriction or danger. This takes time, so on Thursday after sharing I asked us to all pray ONE WORD for the person on their right, based on their expressed need. Many of those words were peace, surrender, courage, trust, flexibility, confidence, encouragement, awareness of beauty, be smart, resist pressure. My word was paradox.<br />
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Because like Jesus approaching Lazarus' family, I find this season to be a constant holding of tension. There is a genuine need for entering into our fears, lamenting our losses, naming the sorrow. When Jesus met Mary, he wept. No words. This is an unprecedented year in human history--we have had equally deadly plagues, but not with the global connectivity to experience not only our local trauma but stories and statistics from around the world. We have had dangers, but there were always places that offered escape and safety.<span style="font-size: large;"> So the first pole of the tension is to just settle into the hard reality of just how NOT RIGHT this moment is. But the second pole, like Jesus with Martha: we also need truth. I am the resurrection and the life, He said. Death is horrible but not the final word. Weeping endures but does, eventually, end.</span> I don't know when that will be, or how, or what the next months will look like. But we keep trying to glean truth from God's promises, and truth from the medical studies, from colleagues, from discussion.<br />
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And at any moment, I don't know who is a Mary and who is a Martha.<span style="font-size: large;"> Who needs an ear and a tear, and who needs a verse and a policy.&nbsp;</span><br />
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<span style="font-size: x-small;"><i>small gatherings outside shops</i></span></div>
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<span style="font-size: x-small;"><i>cocoa is becoming scarcer</i></span></div>
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<span style="font-size: x-small;"><i>when the storms knock the mangos down before they are ripe, making mango crisp is a taste of beauty</i></span></div>
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<span style="font-size: x-small;"><i>Milk and eggs from the market, walking up the road.</i></span></div>
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<span style="font-size: x-small;"><i>For my family in NC where evidently bread is now out of stock . . . we have bread!</i></span></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-72258739170647516462020-03-26T03:24:00.002-07:002020-03-26T03:24:48.875-07:00#COVID-19UGANDA; A complex emergency response day 5<div dir="ltr" style="text-align: left;" trbidi="on">
Uganda cases are now14, out of 308 tested. We are still in the phase of only suspecting travellers, so if the coronavirus entered months ago and has been persistently and relentlessly spreading, we don't know. So far only one test has been done in Bundibugyo, and it was negative, so we have no idea locally either.<br />
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Five minutes ago, the third neighbour/acquaintance of the day came to say that they needed help. Food prices in the market shot up as soon as the first cases were announced. With borders closed, markets limited, movement discouraged, school children sent home, <span style="font-size: large;">the average person here is not as concerned about dying of the virus as about going hungry</span>. The main cash crop, cocoa, has already become much less valuable as European markets imploded. So our friends say, here we are at home, sitting with nothing, and not sure what we will eat. Uganda is a fertile country but also a crowded one. The average household here will be more able than most places to survive from a garden, from the land, but it will still be hard. Most markets have been closed down.<br />
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Every day, almost, the president speaks and announces <span style="font-size: large;">new restrictions</span>. Last night he canceled all public transport--all buses, matatus, bodas, trucks. Now motorcycles can deliver packages but not people. VERY FEW private cars exist, so this is an effective way to shut off movement. There are road blocks now set up between our town and the border. Questions are asked and the military is serious.<br />
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Our teachers spent the week working on take-home assignments to be distributed to our 357 CSB students tomorrow. They had a plan to go tomorrow to seven points around the district, and hand the hefty packets out to the students forced home a week ago. Only <b>now everyone is afraid to do that,</b> lest we be accused of causing unlawful gathering. The government did approve the plan to have teachers get radio time, but with transport shut down, even that might not happen. Wealthier elites will have TV and internet in the cities; our students will have nothing.<br />
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<span style="font-size: x-small;"><i>That is the floor, something that is usually covered with mattresses and mats and blankets and kids</i></span></div>
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Medical care continues, but as expected, patients are afraid too. Maternity was still full. Paeds was down to 100% full, meaning only beds and not the floor. And to add insult to injury, I saw the first case of measles in about six months. Last year this time we were in a major measles pandemic, but the concerted efforts of vaccination teams over the course of 2019 really made an impact. Measles is even more contagious than coronavirus, and deadly. In fact over 140,000 children/year have died of measles the last couple of years, due to failure to vaccinate. So far this year, 20,000 people have died of coronavirus. (Begging the question of, will everyone get a coronavirus vaccine if it becomes available, or not!? The COVID-19 risk to people under age 50 is probably similar to seasonal influenza; how many of those got a flu vaccine this year??).&nbsp; My case yesterday was a 6 month old, meaning he had not yet been old enough to get the vaccine, and missed the special campaigns of 2019. His illness also means that there is active virus circulating in his community. So in the midst of COVID-19 preparedness and anxiety . . . we had to call for another team to go out and investigate measles.<br />
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<span style="font-size: x-small;"><i>Measles rash in an otherwise quite robust 6-month-old</i></span></div>
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<span style="font-size: large;">Which illustrates the point of a complex emergency.</span> COVID-19 is here, and it will cause harm directly to many people who will suffer. But it is also already causing collateral damage. How many malaria patients didn't get treatment this week because they were afraid to come to the hospital? How much will measles, or HIV, or gastroenteritis surge as all attention is diverted? How will the economic downturns translate into malnutrition, or domestic violence, or dropping out of school?<br />
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And while we track Uganda, and serve Bundibugyo, we also keep our eyes on the global escalation, remembering that the actual cases are probably 10x the confirmed cases (or more). So for our team, there are so many layers of trauma. Hearing and watching our community and friends suffer all around us. Working to prepare for the worst when we know how limited we are. The ever-present possibility of getting sick. Watching other Americans evacuate Africa (not now that it's all closed down, but a few days ago) and choosing to stay, then second-guessing that. Fielding well-meaning queries from family and friends who ask, so, if you get really sick what will happen, and not being able to give reassuringly confident answers. In the wee hours of the morning, thinking, what if I am the small percentage who needs an ICU, which does not exist? Or, how long can we manage if power, or banking, or markets, completely stop? Communicating with family and feeling their pain, jobs lost, restless isolation, canceled plans, looming worry.<br />
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<span style="font-size: large;">These are real questions, and we are real people, who are in this global storm.</span> Most of the times in our life, we slap a prayer onto what we subtly truly trust: the medicine, the expert, the evacuation, the plan. But there are sometimes seasons when our illusion of control is completely stripped away.&nbsp; Preterm labor in a place that at the time had no capacity to care for a preem. Walking with a crowd of about-to-be-refugees towards the Congo border with gunfire behind us. Taking our temperature for 21 days in an Ebola epidemic where we had been exposed, and there was no option to leave. And now.&nbsp; <span style="font-size: large;">So what is our comfort? That the presence and good intent of God towards us cannot be interrupted by anything, not war, not disease, not edicts, not even death. And though I can type that as truth, I will not pretend that I can feel that in my bones at all moments.</span><br />
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Peter had to step out of the boat into the storm, God's people had to step into the Jordan and run towards the battle, to see the miracles. The ones who said, we can't put our children at risk (Num 14:3), did not live to see the promised land. So day 5, here we are, putting in a toe and holding our breath for the rescue.<br />
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com2tag:blogger.com,1999:blog-8176735909708151146.post-595714897674262572020-03-24T04:26:00.000-07:002020-03-24T11:24:44.279-07:00#COVID-19UGANDA day 2-3; escalation and preparation<div dir="ltr" style="text-align: left;" trbidi="on">
Our first confirmed case in Uganda was announced Sunday. Today we have 9 known cases, all in the capital. But since the extra 8 came from testing 35 more recent flight arrivals, if a quarter of the tests were positive we have to assume that hundreds have entered and the virus has spread. The chance that our cases from Dubai represent the absolute first cases to enter the country are vanishingly small. Kenya and Uganda are both awaiting the now nearly-daily addresses from our Presidents. We had borders closed, airports closed, churches and mosques and bars and schools closed. Kenya limited the number of people on matatus and buses, and locally our district pronounced only ONE passenger (in addition to the driver) per boda (motorcycle taxi). Today we expect more draconian rules. Meanwhile the worldwide exponential curve grows. The USA is filling with the red circles. Luke and Abby are working extra shifts. Jack's town is in lock-down, so he's writing his graduate school papers from his room. Julia is still allowed to work on her farm, which seems like a pretty essential service. Caleb is completing a language course today and in limbo with the army after that.<br />
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Day 2 out here in Bundibugyo started with a war council. On Friday, we had a staff CME, but the positive cases in Kampala over the weekend brought the reality home. Thankfully Dr. Ammon our medical superintendent and dear friend, who got a sponsorship to med school thanks to the post-Ebola scholarships, had started daily morning staff meetings a few weeks ago.</div>
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So Monday, we worked through a 6-part plan based on experience in Hong Kong and Singapore protecting health care workers. <b>Wearing masks, hand hygiene, cleaning surfaces, triage, isolation with more extensive PPE for the suspect cases, keeping distance.</b> Those six things we can do. I find that when I read what other hospitals are preparing, with advice like "you should have 10L/min flow of oxygen for every bed" and we have a total of about 20L/min for 24 hours in the ENTIRE HOSPITAL . . it does feel panicky. So we try to focus on the simplest measures.&nbsp;</div>
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After the meeting, Dr. Marc organised final disposition of a medical supply container that had arrived more than six months ago. It was stuffed with lots of marginally useful items, but last week he found some N95 masks. Many, actually, and some PPE. That means that more than 2 years ago, God enabled a former missionary to prepare this container and it was sitting there at just the time we needed it. Pretty amazing.</div>
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Don't cringe if you're an infection control nurse but our reality is that we will wear our masks all day, not changing them, and take them off and store them with hygiene, and then re-use it for a week. Our reality on Paeds is that half our patients have respiratory illnesses, and zero attempt to limit their coughs. So we're wearing them now to get used to it. Half of me felt out of breath and suffocating as temps soar over 90 (no A/C on the equator, congested and stifling). But most of me felt relieved that I was not breathing in a corona soup.</div>
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While Marc was sorting and Jessie, Clovis, and I were seeing patients, Scott was pulled into a District response meeting.&nbsp; Christ School closed Friday, so he came to the hospital to resume his long-delayed clinical life. Only to be diverted yet again into politics and leadership. (Below with Dr. Ammon and head admin Francis, keeping their #social_spacing)</div>
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For Bundibugyo, on a border, security is a primary issue, so the meeting with all sectors was a mix of medical and military.</div>
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The ward was still full, but full in a way that only maybe 1/5 of patients were on the floor and there were visible areas of floor with no patients. Meaning perhaps that people will start avoiding the hospital as the pandemic picks up. Which could be wise, but may be fatal. I suspect for kids we will lose untold numbers to malaria, sepsis, anaemia, other pneumonias and infections, diarrhoea and dehydration, untreated malnutrition, because the non-COVID health care will wane. We made a new diagnosis of HIV infection in a couple with a very sick baby. Getting people treatment for other fatal disease is still important.&nbsp;</div>
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Patients like this one make me pause. Her respiratory rate was over 40, her saturations were about 90%, her breath sounds were decreased. Is this a run-of-the-mill virus or the new one? Will we ever know?&nbsp;&nbsp;</div>
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After six straight hours of crouching and leaning, listening and writing, searching and explaining, everyone had been seen. We walked out into the blazing sun and washed hands in bleach, removed our masks and sprayed them with alcohol and put them in a bag, then washed our hands with bleach again.&nbsp; Back to our house for another many hours of emails, texts, phone calls, a Serge emergency committee meeting by zoom, listening to concerns, praying with team mates.&nbsp;&nbsp;</div>
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These are tense days. The weight of our zero-options existence seems to increase with every passing day's pronouncements.&nbsp; <span style="font-size: large;">Real prayer, writes Eric McLaughlin in <i>Promises in the Dark</i>, is fundamentally helplessness.</span> I think we're really praying. now. Evacuation insurance doesn't help if the borders are shut. Knowing how to manage a ventilator doesn't help if there is no ventilator. We have some oxygen but it seems pitifully small. Yet we know that God can preserve our lives. We just don't usually feel like we need Him to, we usually feel like we're applying ourselves to that process.&nbsp;</div>
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And we do get glimpses of why <b>there is meaning and value in this season of risk. </b>It is a privilege to stand with the least-resourced people on earth and fight a pandemic that affects everyone around the globe. It is encouraging to them to feel they are not forgotten or alone. Sometimes we actually offer something, like our stash of masks! Other times we just offer hope.</div>
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We may not be able to do this again very soon, but this was our team worship. We're basically a big family, and we took the 2 Chron verse seriously: we don't know what to do, our eyes are upon you. Like the original pray-ers of that prayer, we met the enemy with worship. This is what faith looks like where we are, on the edge. Helpless to stem the tide, but seeking the presence of God in the sea of uncertainty and glimpsing ways (masks! friends!) God provides.</div>
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And like everyone else around the world who has a phone, our days often end with a message or call with family, who are in more intensely affected areas and being very obedient quarantiners.&nbsp;</div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0tag:blogger.com,1999:blog-8176735909708151146.post-48572728858196429972020-03-22T12:20:00.000-07:002020-03-22T12:20:03.734-07:00#COVID-19UGANDA day 1; May it be light and may we be light<div dir="ltr" style="text-align: left;" trbidi="on">
In the few hours since yesterday's post, Uganda has joined the 169 countries around the world with cases of the SARS-CoV-2 induced illness, COVID-19. Our first identified case was a 36 year old Ugandan man who went to UAE (Dubai) on business and returned to Uganda ill. He was identified in screening at the airport, isolated, and tested.<br />
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While his test was still pending, the President instituted new restrictions. Borders are now closed. No passenger planes may land or depart as of midnight tonight. No one can ride a bus or a boda or walk or bike over a land border, or take a boat over the Lake borders. If you are in Uganda now, you are here for the foreseeable future. If you wanted to come back, it's too late. Cargo and UN movement only.<br />
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<a href="https://1.bp.blogspot.com/-0a5MXXF95cs/Xne6NacVFSI/AAAAAAAAWZI/un3_THkrq1gf6Y1ZMVbO8fsvg9pbsqFrACLcBGAsYHQ/s1600/covid%2Bmap%2B22.3.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="822" data-original-width="1600" height="328" src="https://1.bp.blogspot.com/-0a5MXXF95cs/Xne6NacVFSI/AAAAAAAAWZI/un3_THkrq1gf6Y1ZMVbO8fsvg9pbsqFrACLcBGAsYHQ/s640/covid%2Bmap%2B22.3.png" width="640" /></a></div>
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World cases now well over 300 thousand, with 14 thousand deaths.<br />
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Here is what we don't know: in most countries, the first identified case came when hundreds had most likely already been infected. Here's what we also don't know: how bad will it be, what will the hospital look like, how quickly will the commerce shut down, what will the security implications be? Salt prices doubled immediately. Cocoa prices are dropping with the lack of a European market. Security fired tear gas to disperse the usual market as a meeting place.<br />
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We are all in this together. The only way to get to the other side is to pass through whatever the next months hold, together. "Social cohesion with spacing" sounds better than social distance. 1 Peter 3:8 calls upon us to have unity of mind, sympathy, brotherly love, a tender heart, and a humble mind. Young people are restricting their freedoms, to protect their grandparents. Neighbours are looking out for their neighbours. Nurses and doctors are showing up for dangerous work, advocating, improvising. Creative people are reaching out on line to lead exercise classes or read books aloud. Pastors are preaching online.<br />
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And God's people are responding like they have for centuries. Martin Luther <a href="https://blogs.lcms.org/wp-content/uploads/2020/03/Plague-blogLW.pdf">wrote in 1527 a very long letter</a> answering the question of whether it was permissible to flee the plague.&nbsp; In the middle ages, ships infested with flea-ridden rats were the globalizing force of trade and the vectors of plague, much as the incredibly connected airlines have allowed a respiratory virus to spread worldwide in a matter of weeks in our century. His letter is remarkably nuanced. Believers should not seek death; God has created each life and we are right to extend life to do good. He very practically recommends use of medicine, fumigation of housing, rest, and even avoiding places of illness where one's help is not needed. But that right is tempered by the imperative to serve one's neighbour. Love inherently carries the reality of risk. He writes that if it is possible to be more safe without hurting or abandoning others, we should, but then says:<br />
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<i><span style="font-size: large;">Now if a deadly epidemic strikes, we should stay where
we are, make our preparations, and take courage in the fact
that we are mutually bound together.</span></i><br />
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&nbsp;Social cohesion, resting on God's promises to care for us and showing God's mercy to all. Social spacing, to protect others as best we can. Social risk-taking if you are an essential worker, a first-responder, a health care worker, a farmer, a person who keeps electricity and water and fuel available.<br />
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These are sobering times, and incredibly complex decisions. We know that here in Uganda we are only at the very beginning of the exponential upswing the USA is now experiencing. This is one plague that you really can't flee; there is no place on earth likely to remain unaffected.<br />
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Our youngest, newest team member prayed this prayer, which I believe captures both the legitimate desire to escape harm and the determination to do good; much like "Lord I believe, help my unbelief" (shout out to Lindsey):<br />
<span style="font-size: large;"><b><i>Lord, may the pandemic in our country be light.</i></b></span><br />
<span style="font-size: large;"><b><i>And as it comes, help us to be light.</i></b></span></div>
DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com2tag:blogger.com,1999:blog-8176735909708151146.post-24817874232498978702020-03-21T08:23:00.003-07:002020-03-21T08:23:54.517-07:00We don't know what to do . . . COVID-19 and 2 Chronicles 20<div dir="ltr" style="text-align: left;" trbidi="on">
Here are some words written several thousand years ago, but applicable today: <span style="font-size: large;">"For we have no power against this great multitude (or virus) that is coming against us; nor do we know what to do, but our eyes are upon You."</span><br />
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When God's people were backed into a corner, with no hope, facing annihilation, this is what they said.<br />
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I don't even know how many times a day we have to make a major decision based on very little information, conflicting reports, impossible projections, with grave consequences. We don't know what to do. Or the times, here and there, when the weight of losses and the gravity of potential sorrows just feels overwhelming.<br />
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So here's what it's like at the end of the road this week, in one of the few countries left that has not yet reported a positive test.<br />
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We supervise 79 adults and 72 kids for Serge East and Central Africa. Two of our four countries have had low numbers of imported cases reported, two have not. Yesterday the US Department of State issued their most dire, war-like, travel warning ever: If you're an American on a trip, come home now. If you're an American that lives abroad, stay put and don't travel. Which means that there was a sudden calculation by and for 151 souls, do I live here or am I visiting? What is my risk? Should I leave? And these are not simple questions. A delay of a day could mean flights stop and borders close. We had already made sure our only over-65 people were off the continent, not because the rest of the world is safer, but because IF THEY were in critical condition there were NO OPTIONS for them to be in an ICU. But even younger people can have critical disease. Where do we say, your life is valuable, we want to protect you, it's our job to get you back to a place where the health system might be able to support you? And where do we say, your choice to shoulder this risk speaks of the Gospel to your community, and we want to allow you to stay in the long tradition of the church and pandemics? These are not simple questions. They have multiple right answers. We don't know what to do, our eyes are on You.<br />
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In most of our life here in Africa, we have a hidden privilege. When security deteriorates, when Ebola arises, when family at home is ill, when we are weary, we can usually pick up and take a break.&nbsp; But not now. After 9/11 felt similar to this. It is a whole new level of faith to live in a place of poverty and margin, when you can't leave. Our colleagues are cognisant of the fact that if a treasured grandparent dies, if an adult child breaks a leg, if a two-year-old needs a special surgery, if any one of a thousand crises arise related to coronavirus or not, we most likely cannot go anywhere. Today my mom called with the news that my Aunt who is nearly 90 fell and hit her head and is in the ICU with bleeding in her brain. I hope I will see her again, but it is quite possible I won't. On that note, a shout-out to all our parents who are strictly quarantining. It is a tremendous relief to your distant family to know that you are sacrificing your freedoms, you are giving up movement out and about, to protect yourselves. We are so grateful. We don't know what to do, our eyes are upon You.<br />
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Usually, we live in rhythms. After a few months, there is a. break. We look forward to conferences or trips. The day to day slog of heat and need can be wearing, the distance gets draining. It is a whole new layer of difficult to not know when we might see our kids again, or our parents, or many others. Or even when we might see our other teams. Or get to a place with swimming or quiet. We don't know what to do, our eyes are upon You.<br />
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Africa is braced. Our country shut down schools, churches, bars, gatherings, sports. We spent time scouring up some facemasks and hand santiser.&nbsp; I taught a CME for the hospital yesterday on the novel coronavirus. Teams are researching the best approaches. Our hospital set up handwashing stations outside every ward (since water and plumbing is not always reliable, these are refillable jugs). But once in side the ward, there is extreme crowding. All but two of our teams have a core of medical work. When the world stops moving, and people stay home, almost all of our missionaries in Africa are in a different category of essential workers. We are watching Italy on the news and wondering, if they had hundreds of deaths yesterday, how can we possibly not be even worse? Our population is malnourished. We have immune compromise from HIV, we have lung damage from TB, we have a high prevalence of malaria. We have about 9 oxygen cylinders, each of which will give a low flow for one patient for about 24 hours. We have no ICU. No ventilator. No oxygen plant. The ratios of health care workers to population where we work is among the lowest in the world. Options are so limited, for our neighbours, for all of us. We don't know what to do, our eyes are upon You.<br />
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<span style="font-size: x-small;"><i>These are the measures Uganda announced this week</i></span></div>
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<a href="https://1.bp.blogspot.com/-q3eA_wPLsdg/XnYv-0QlSAI/AAAAAAAAWYk/VGmNHni7BroD8GIh3V4KP57DoOFWa05cACLcBGAsYHQ/s1600/handwash%2Bcan.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-q3eA_wPLsdg/XnYv-0QlSAI/AAAAAAAAWYk/VGmNHni7BroD8GIh3V4KP57DoOFWa05cACLcBGAsYHQ/s320/handwash%2Bcan.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>This little can of water with a spigot is our defense against the pandemic</i></span></div>
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<a href="https://1.bp.blogspot.com/-xDG1tu_fMpY/XnYv-y_ukPI/AAAAAAAAWYg/NMHum7G1nWw3WL0C45u6t-hkqPKLdSnIwCLcBGAsYHQ/s1600/kwash%2Bfeet%2Bedema.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-xDG1tu_fMpY/XnYv-y_ukPI/AAAAAAAAWYg/NMHum7G1nWw3WL0C45u6t-hkqPKLdSnIwCLcBGAsYHQ/s320/kwash%2Bfeet%2Bedema.jpeg" width="240" /></a></div>
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<span style="font-size: x-small;"><i>Collateral damage. This child from yesterday is swollen from lack of protein, a mom who was too soon pregnant again, no good food options without breast milk. When the pandemic hits, what happens to kids like this?&nbsp;</i></span></div>
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&nbsp;<a href="https://1.bp.blogspot.com/-ZT1Tte9MvpA/XnYwAsNEZXI/AAAAAAAAWYw/7A4MTrYVzCsL-Rumu1A7f9A4k6mtBc-eQCLcBGAsYHQ/s1600/teaching%2Bcme.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="810" data-original-width="1080" height="240" src="https://1.bp.blogspot.com/-ZT1Tte9MvpA/XnYwAsNEZXI/AAAAAAAAWYw/7A4MTrYVzCsL-Rumu1A7f9A4k6mtBc-eQCLcBGAsYHQ/s320/teaching%2Bcme.jpeg" width="320" /></a></div>
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<span style="font-size: x-small;"><i>Teaching CME. Everyone usually sits physically touching; it was our first time to space ourselves out like this. But this is a team who has worked through cholera and Ebola and untold crises. They can do it.</i></span></div>
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Christ School closing, all schools closing, hits Bundibugyo hard. Our students don't have internet access. There won't be online anything options. They are returning to homes which have no books, no electricity, perhaps even limited food. We struggle to keep up with the national curves even with all our school days; doing so with half the term canceled (or more??) will push us to the limits. The teachers are staying around to create a packet of work sheets since no one has texts. Monday Scott and Patrick will meet district leaders with a plan to teach on the radio, a gesture of good will, a way to come together in crisis and bless kids from many schools. With no church, no sports, no school, no books, few outlets, what will the impact be on this generation if this lasts very long? We don't know what to do, our eyes are upon You.<br />
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And so the days go, dozens of texts, hundreds of messages and emails, calls at all hours. Trying to stay alert and empathetic. Giving grace to various people in our orbit to make different choices. Wanting everyone to feel seen, cared for, supported. Then long days of the normal work of serving sick kids and their families. The disorienting feeling, is that cough evidence that the new coronavirus is already here? Is that fever potentially dangerous? Should I start using precious masks or wait? If we can barely make it through the ward where the patients cover not just the beds but the floor now, what will it be like in two weeks? In a month? We don't know what to do, our eyes are upon You.<br />
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<span style="font-size: x-small;"><i>In an era of distance, the group was giving me "roses", picking them from the air and throwing them to me to receive after teaching, rather than a clap our hand shake.&nbsp;</i></span></div>
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We are praying for our world. For God's powerful rescue. For a 2 Chronicles 20 story, where we find out in the end that God was with us all along, that our worst fears are already defeated, that we are going to be all right. That in the end, because our eyes are on God, all shall be well.<br />
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-62758493381445727912020-03-17T11:22:00.000-07:002020-03-17T11:22:02.310-07:00The 80/20 rule of Coronavirus, Kindness, and antidotes to fear<div dir="ltr" style="text-align: left;" trbidi="on">
As everyone but a dedicated hermit must know by now, 80% of people infected with Sars-CoV-2 aka the coronavirus that causes COVID-19, our pandemic respiratory infection, will have mild infections. It's the 20% who get the disease in older decades (like, gulp, ours) or who have chronic debilitating health issues, who get very sick.<br />
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<a href="https://1.bp.blogspot.com/-eRDO1ZT5Tx4/XnETcKtxuMI/AAAAAAAAWXQ/r9QiK9j8b7A-pEswGBeyaFWnt1gAtOyTgCLcBGAsYHQ/s1600/saraya%2Bhand%2Bsanitier.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-eRDO1ZT5Tx4/XnETcKtxuMI/AAAAAAAAWXQ/r9QiK9j8b7A-pEswGBeyaFWnt1gAtOyTgCLcBGAsYHQ/s320/saraya%2Bhand%2Bsanitier.jpeg" width="240" /></a><br />
I learned from my Kenyan colleagues, who are used to massive numbers of patients in the public health system, that as a doctor we need to find the 20% who are most sick and give them 80% of our attention. That is no less true now. MOST of our concern, effort, preparation, needs to go to our most vulnerable. In this year of pandemic, <span style="font-size: large;">that means that 80% of us have to alter our behaviour to protect and love the 20% who are at risk.</span> People are changing their lives, overnight. Giving up freedom. Travel. Habits. Churches and schools, closing. It's a massive effort by the relatively well to protect those most vulnerable should they become sick.<br />
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And some people are <b>doing so in a very inspiring way.</b> I love the videos of Italians, and Spanish people, on their balconies singing and clapping. They are social distancing physically, but not emotionally. Zion Williamson, the Duke basketball phenom who went to New Orleans, decided to pay the salaries of the arena workers whose jobs would be impacted by the shutdown of the basketball season. He's a 19 year old; his trajectory to wealth was so rapid he hasn't forgotten. Julia's church farm is providing food for people, and started a program to cook up large batches of nutritious broth. Luke and Abby had to give up their long-delayed honeymoon planned for April; Luke is back on straight night shifts next week for emergencies after having already put in his two-months of that in January and February, because that's what's needed as the health system narrows down its focus. Abby is working extra shifts, and both of them already have COVID-19 patients in their hospitals. Our moms are in isolation hoping as 80+ people to avoid the virus altogether. Friends are lamenting the loss of time with children or grandchildren, the honing down of wedding lists, the inability to celebrate milestones. Yet I see people posting ideas on how to help your neighbour, <span style="font-size: large;">how to be grateful and generous which is an antidote to fear.</span><br />
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There is another 80/20 rule at play.&nbsp; On a global scale, the poorest countries are those 20% vulnerable. It is not just age and pre-existing health conditions. <span style="font-size: large;">It's other pre-existing conditions. Like poverty. </span>Like a health system that doesn't even have ICU care or much in the way of oxygen. 155 countries are now reporting cases. Amongst the handful which are not? Uganda, and Burundi, two of the places we work. Yes, they are remote to get to and perhaps slow to receive travellers, but more likely they just don't have enough testing to really know what is happening. Interestingly there is only one state left in the USA without reported cases, West Virginia. On the WV:USA scale; or the Bundibugyo and Burundi : Africa scale, there are similarities. A study found that WV had the adult population with the worst health in the USA, so when COVID-19 hits, they will be severely affected with minimal resources. We anticipate the same here. No one knows the impact of HIV prevalence mixed with this pandemic. Or malaria, or malnutrition.<br />
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So here we are for a couple of days in the capital. (We were called to the State House's office on Land Matters because of the 6-year law suit trying to steal back land bought 20 years ago. That turned out to be an unpleasant morning of being told by a young lawyer that, and I quote loosely but sadly pretty accurately, we might lose our lives over this but hey everyone dies whether it's a bullet or old age, so just trust the courts. . . . the meeting was miserable but seeing the support of the community who sent multiple witnesses to explain how the mission's work was of value to them, and how they all feared the injustice being perpetrated, was pretty heartening.) Our couple of days here consist of scouring pharmacies and calling contacts who know the market from 25 years ago (no lie, the same guy who used to help us procure flour and rope and fuel when those were rare items today came up with some N-95 facemasks and hand sanitizer, no easy task when some enterprising person sold all of Uganda's supplies to China a month or two ago) for medical supplies. We're shopping but not for massive amounts of toilet paper (we LIVE NORMALLY in increments of months between access to groceries, so we generally stock up on peanut butter and beans and popcorn and cheese . . and one or two packs of TP). In between life-maintenance and medical-supply searching, we answer emails and talk to our people. We supervise dozens of adults and dozens more kids in four countries. Some are older than others, some are pregnant. Some are anxious. Many are health care workers. All of us have always had the sense that worse comes to worst, we can probably evacuate. We don't have that anymore. We are coming to new normals of facing an impending pandemic with inadequate supplies, of looking for weeks or months of being isolated from our origins. And the peculiar experience of being visibly indistinguishable from whomever brought the virus to our countries. We're in the guilty minority this time.<br />
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One more day and we'll head back. None of us know what the next weeks and months will hold.<br />
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But God does. We don't have ventilators or chest CT scans, labs or blood gases, high flow oxygen or access to tests. But we do have communities that would come to Kampala to testify for the good God is doing in our homes. We do have a genuine team of people in East and Central Africa sharing information and praying for each other. We do have some simple energy to care for the sick, to comfort, to support. We do have a few facemasks and bottles of sanitizer to stem the onslaught of virae. And we do have a promise, that nothing can separate us from LOVE.<br />
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<i>This is today's paper. If our schools close tomorrow, please remember these kids will return to homes with no books. No computers. No online alternatives. They will not be fed at public lunch programs. They will be severely impacted.</i></div>
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<i>All entrances in Uganda in the city look like this--hand sanitizer and warning posters.</i></div>
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<i>The group that came from Bundibugyo to support us.</i></div>
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<a href="https://1.bp.blogspot.com/-DkcenymjenE/XnETcOh-7oI/AAAAAAAAWXU/Y8H8cPelMRUFp7U1Vq8iPfJ_TaxOJzmxQCLcBGAsYHQ/s1600/with%2Bla%2Brochelles.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-DkcenymjenE/XnETcOh-7oI/AAAAAAAAWXU/Y8H8cPelMRUFp7U1Vq8iPfJ_TaxOJzmxQCLcBGAsYHQ/s320/with%2Bla%2Brochelles.jpeg" width="320" /></a></div>
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<i>Kenya announced cases and a closing border but by the mercies of God this family was able to get from Eastern DRC where the Ebola epidemic is waning, to Kenya where they can more safely deliver a baby in May. Praying for them!!</i></div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-56844234177752060402020-03-14T01:11:00.001-07:002020-03-14T01:14:10.664-07:00 Pre-Coronavirus Realities on Friday the 13th<div dir="ltr" style="text-align: left;" trbidi="on">
Friday the 13th, as America declared a National Emergency, our Serge organisation met to discuss travel policies, lots of phone calls and texts to make decisions and cancellations, the first case of COVID-19 in East Africa was diagnosed in Kenya in a person who had traveled from the USA . . . and life went on in Uganda. Meaning 8 am at the hospital, finding a young child who had been admitted the day before with a viral lung infection (presumably NOT coronavirus, there are so many virae), been on oxygen and convulsing overnight, and was now having intermittent agonal breaths. The shift had just changed, we did what we could which was not enough, and she died.&nbsp; The morning staff meeting, the realisation that no other doctor was in the hospital today (politics, interviews, post-call exhaustion, planned travel). Bouncing between a packed ward and the newly opened NICU. Premature twins on day of life 3, doing what preterm twins do--getting jaundiced and losing a little weight but otherwise vigorous. But a baby admitted overnight whose mother had delivered a twin on the way to the hospital but not been able to get this one out. No records to say how long it took to get a C section or what the apgars were, but the baby was limp, blue on CPAP, with unresponsive pupils. Also dying.<br />
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Then back to the ward, facing what the records said was 81 patients but probably was more like 70-some, with what felt like no help. No vital signs charted. No one charting much of anything. Just bed to bed, mattresses on the floor, scribbling in exercise books, talking to parents, doing exams, making decisions, ordering labs and medicines, trying to find the sickest but salvagable. There was something about starting with two deaths and unexpected aloneness in the context of a pandemic that just threw me into despair. I texted a few team mates to pray. Scott sent back an encouraging message.&nbsp; And by grace, we plugged on.<br />
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Once I just set myself to see the patients one at a time, to look at the little humans as humans and their parents as parents, to not worry about doing it ALL but just focus on doing the next thing, the day changed. I wasn't alone. There was a nurse in the injection room giving meds, and one in the office writing discharge papers. Later another came to help me get more kids on oxygen. Clovice our every-cheerful BundiNutrition aid was there, and even though he's not medically trained he's faithful and dependable, and recognized two of the sickest patients to call my attention to.<br />
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So here is a glimpse of rounds, on a normal day.<br />
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<a href="https://1.bp.blogspot.com/-oaFdQbhlowE/XmyEay0ibAI/AAAAAAAAWVo/4bwg7feIE5UvjCjj--AH9lRuxMDoDLCVQCLcBGAsYHQ/s1600/back%2Bof%2Bpaeds%2Bward.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="400" src="https://1.bp.blogspot.com/-oaFdQbhlowE/XmyEay0ibAI/AAAAAAAAWVo/4bwg7feIE5UvjCjj--AH9lRuxMDoDLCVQCLcBGAsYHQ/s400/back%2Bof%2Bpaeds%2Bward.jpeg" width="400" /></a></div>
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Typical section of the ward, when the beds fill patients just add mats and mattresses to the floor.</div>
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Ants enjoying the dripped IVF, evidence I suppose that the dextrose label actually DOES include dextrose.</div>
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<a href="https://1.bp.blogspot.com/-C6hmmbUNQh4/XmyEbRWGvRI/AAAAAAAAWVw/MatwDaxXjJcOy5iEe3C4uRzy7KuQPjPywCLcBGAsYHQ/s1600/drawer%2Bof%2Blab%2Bresults.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-C6hmmbUNQh4/XmyEbRWGvRI/AAAAAAAAWVw/MatwDaxXjJcOy5iEe3C4uRzy7KuQPjPywCLcBGAsYHQ/s320/drawer%2Bof%2Blab%2Bresults.jpeg" width="320" /></a></div>
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Looking for lab results, discovered dozens from the last few weeks jammed into this drawer.</div>
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As if being under the Ebola into poster wasn't bad enough, this kid accidentally cut his heel down to bone FOUR DAYS AGO, came to the hospital two days ago and happened to get tested for malaria, which was positive. His hemoglobin was very low as blood poured out of his heel and parasites attacked what was left. Evidently his hand-carried record book got displaced, so until I found him bleeding away nothing had been done yet . . .</div>
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<a href="https://1.bp.blogspot.com/-1fhJaq_JfG8/XmyEcUfXwBI/AAAAAAAAWV4/e3mEcTta1j4xmo2mSgKU4Z9NgkZlC8NXACLcBGAsYHQ/s1600/hb%2B1.4.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="400" src="https://1.bp.blogspot.com/-1fhJaq_JfG8/XmyEcUfXwBI/AAAAAAAAWV4/e3mEcTta1j4xmo2mSgKU4Z9NgkZlC8NXACLcBGAsYHQ/s400/hb%2B1.4.jpeg" width="400" /></a></div>
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She survived malaria with vomiting blood, and a hemoglobin of 1.4 on admission (normal 12). In spite of exceptions like the kid above, we have made good strides on malaria and transfusions. Our nurses can inject artesunate (and ampicillin) and hang blood transfusions. Those three things save a lot of lives actually.</div>
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<a href="https://1.bp.blogspot.com/-Y1PoThuau-A/XmyEZl71iJI/AAAAAAAAWVk/sNQsNc7YGvofDzgDRWNn1_sAxf58uGl3gCLcBGAsYHQ/s1600/MRDT%2Bpositibve.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="400" src="https://1.bp.blogspot.com/-Y1PoThuau-A/XmyEZl71iJI/AAAAAAAAWVk/sNQsNc7YGvofDzgDRWNn1_sAxf58uGl3gCLcBGAsYHQ/s400/MRDT%2Bpositibve.jpeg" width="400" /></a></div>
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Malaria is so endemic that we try NOT to let anyone go home that was not tested. This boy was ready for discharge, his pneumonia better, but he had a palpable spleen. So I had to finally march him into the appropriate blood testing area and insist, and wa la, malaria. So he'll go home on treatment. Yeah.</div>
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<a href="https://1.bp.blogspot.com/-_V0s8XjUIQE/XmyEch1Cp1I/AAAAAAAAWV8/0oWEEqmv2soijNvszjP3OQgr38QiLrXxgCLcBGAsYHQ/s1600/part%2Bof%2Bward%2Bpaeds%2B.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="400" src="https://1.bp.blogspot.com/-_V0s8XjUIQE/XmyEch1Cp1I/AAAAAAAAWV8/0oWEEqmv2soijNvszjP3OQgr38QiLrXxgCLcBGAsYHQ/s400/part%2Bof%2Bward%2Bpaeds%2B.jpeg" width="400" /></a></div>
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More patients. At this point I was about half way through the ward. Malaria, malaria, malnutrition, sickle cell, pneumonia, lots of viral syndomes, abscesses, burns, hit-by piki, and so on.</div>
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<a href="https://1.bp.blogspot.com/-nIF3KvDWdgM/XmyEc3YgY6I/AAAAAAAAWWA/fvlLvCYrgoUzOLSiIT6d3DwiBwN_qEIkgCLcBGAsYHQ/s1600/sickle%2Bcell%2Bdisease%2Bgirl%2Bwith%2Bhat%2B.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="400" src="https://1.bp.blogspot.com/-nIF3KvDWdgM/XmyEc3YgY6I/AAAAAAAAWWA/fvlLvCYrgoUzOLSiIT6d3DwiBwN_qEIkgCLcBGAsYHQ/s400/sickle%2Bcell%2Bdisease%2Bgirl%2Bwith%2Bhat%2B.jpeg" width="400" /></a></div>
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Don't let sickle cell disease ruin your fashion sense. This hat and smile were so cute.</div>
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<a href="https://1.bp.blogspot.com/-SUc5NXhwGZU/XmyEdLunUoI/AAAAAAAAWWE/KyaCVYOEQkUCbMP3s5fUynGvnnsDeRTxwCLcBGAsYHQ/s1600/snakebite%2Barm.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-SUc5NXhwGZU/XmyEdLunUoI/AAAAAAAAWWE/KyaCVYOEQkUCbMP3s5fUynGvnnsDeRTxwCLcBGAsYHQ/s320/snakebite%2Barm.jpeg" width="320" /></a></div>
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Sometimes a story just grabs me. A one-year-old wakes up screaming in his home at night, and the mom sees a big black snake. Snakes sometimes come into poorly sealed homes and look for warmth, and when you sleep on a floor mat . . .then the baby moves, the snake panics, and there is a bite. This child's arm was swollen and tender up to the shoulder and we could see the double fang marks. But by Friday she was much better and able to go home. The snake escaped, but hopefully that little reptile brain was scared enough to stay away.</div>
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<a href="https://1.bp.blogspot.com/-rMGFaPq5A2Y/XmyEdwUDW1I/AAAAAAAAWWI/1ALpI0cBQ9s66xecVw_uou7qiPcbkfLaQCLcBGAsYHQ/s1600/sparkle%2Bshirt%2Bgirl.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="400" src="https://1.bp.blogspot.com/-rMGFaPq5A2Y/XmyEdwUDW1I/AAAAAAAAWWI/1ALpI0cBQ9s66xecVw_uou7qiPcbkfLaQCLcBGAsYHQ/s400/sparkle%2Bshirt%2Bgirl.jpeg" width="400" /></a></div>
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Another fashionable cure. Little girls and spangles. Mirror image G??&nbsp;</div>
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<a href="https://1.bp.blogspot.com/-d6qJ5ECn7EA/XmyEeEHnIzI/AAAAAAAAWWM/D8WznZ8CX3kLz12QtsdnJdJXBd5W8OQ8wCLcBGAsYHQ/s1600/twin%2B7%2Byr%2Bold%2Bsevere%2Bkwash.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-d6qJ5ECn7EA/XmyEeEHnIzI/AAAAAAAAWWM/D8WznZ8CX3kLz12QtsdnJdJXBd5W8OQ8wCLcBGAsYHQ/s320/twin%2B7%2Byr%2Bold%2Bsevere%2Bkwash.jpeg" width="320" /></a></div>
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This 7 year old is a twin, whom we have followed for several months. She has signs of Kwashiorkor (swollen feet and face, skin lesions, listlessness) which is not typical in her age group. Though she improved a bit on her first admission getting food and malaria treatment, now she has some pneumonia findings, so we decided to treat for TB. With an unaffected twin, it seems to be more than just hunger.&nbsp;</div>
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<a href="https://1.bp.blogspot.com/-6eFs8jlug0o/XmyEfIRqB_I/AAAAAAAAWWU/qYfJECZp8MwisqctUH8BxsODjXRfm85ZgCLcBGAsYHQ/s1600/twin%2Bin%2BNICU%2Bbundi%2Bfirst%2Bpatients.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="320" src="https://1.bp.blogspot.com/-6eFs8jlug0o/XmyEfIRqB_I/AAAAAAAAWWU/qYfJECZp8MwisqctUH8BxsODjXRfm85ZgCLcBGAsYHQ/s320/twin%2Bin%2BNICU%2Bbundi%2Bfirst%2Bpatients.jpeg" width="320" /></a></div>
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The first NICU admissions were a set of preterm twins . . this one getting some natural phototherapy in his home made incubator (thanks Dr. Marc for all the work into getting this set up, and Kibuye/Tenwek/Caleb Fader for the incubator design). There was a bug floating in the CPAP but the baby looked great.</div>
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<a href="https://1.bp.blogspot.com/-gAUfRws8uww/XmyEZuNRtAI/AAAAAAAAWVc/a9DXrDt3NQ8PrOYyNZMZzaqCr7be0qcwwCLcBGAsYHQ/s1600/Wating%2Bpulse%2Box%2Bscreen.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-gAUfRws8uww/XmyEZuNRtAI/AAAAAAAAWVc/a9DXrDt3NQ8PrOYyNZMZzaqCr7be0qcwwCLcBGAsYHQ/s320/Wating%2Bpulse%2Box%2Bscreen.jpeg" width="320" /></a></div>
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You might be surprised to know the typical topic of conversation these moments when I am trying to distract and calm an infant or toddler long enough to check their oxygen saturations and heart rate. The mother is usually saying something to the baby like "see your wife here? Are you going to marry her?" and we are all smiling because this is the normal way infants and grandmothers relate. I am not making that up. Literally many times a day I hear proposals from one-year-olds via their mothers.</div>
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<a href="https://1.bp.blogspot.com/-F0gOaR5beCA/XmyEfDmpSQI/AAAAAAAAWWY/nN19kbu42kAjozYXNmGY2FXJitczuRBzACLcBGAsYHQ/s1600/world%2Bsheets.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="320" src="https://1.bp.blogspot.com/-F0gOaR5beCA/XmyEfDmpSQI/AAAAAAAAWWY/nN19kbu42kAjozYXNmGY2FXJitczuRBzACLcBGAsYHQ/s320/world%2Bsheets.jpeg" width="320" /></a></div>
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This is the newest fashion trend sheet, I probably saw four on Friday. Sort of an American nod with the stars and stripes, but a few snowflakes for good measure and a global skyline.</div>
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And so we go. Examine, talk, think, write, make a phone call, check a dose, lead the patient to the nurse's room for a blood draw or injection if it just doesn't seem to be happening. On a good day, when someone is praying, I can make eye contact and feel empathy and take time to force my tongue into Lubwisi to explain, instead of rushing and feeling overwhelmed and frustrated. I try to go over the sickest patients with the nurses, to do some teaching. I make lists, and communicate with the doctors who might come over the weekend. It takes about 6-7 hours to get through rounds, meetings, treatments, etc. In between each patient, a generous splash of alcohol hand sanitiser.&nbsp; We only have one oxygen tank and one concentrator. I have to choose which two of the four hypoxic patients get the oxygen. All of this is baseline. Before coronavirus.</div>
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<a href="https://1.bp.blogspot.com/-2M89YiTlwes/XmyEfan8f4I/AAAAAAAAWWc/0U_nuaDMVCAZ2Evhe-D3mg6iq-_tMYH8gCLcBGAsYHQ/s1600/xray%2Bwith%2Bpneumonia.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-2M89YiTlwes/XmyEfan8f4I/AAAAAAAAWWc/0U_nuaDMVCAZ2Evhe-D3mg6iq-_tMYH8gCLcBGAsYHQ/s320/xray%2Bwith%2Bpneumonia.jpeg" width="320" /></a></div>
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We have three young boys with chests like this, consolidated pneumonias on one side. They are breathing at twice the normal rate or more. I can see their ribs as they work hard. This is before coronavirus, as far as we know.</div>
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Social distancing, hand hygiene, suspension of travel and gathering . . . these are methods to slow the spread of the pandemic so that the health system can adjust, can cope. But what if your health system already isn't coping?</div>
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<a href="https://1.bp.blogspot.com/-q94HNVJpXdY/XmyEeLOQ38I/AAAAAAAAWWQ/wUx5BhwaaFUxTtcMA2yYC85Ea-_Uk0NxACLcBGAsYHQ/s1600/to%2Bdo%2Byou%2Bgood%2Bin%2Bthe%2Bend.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://1.bp.blogspot.com/-q94HNVJpXdY/XmyEeLOQ38I/AAAAAAAAWWQ/wUx5BhwaaFUxTtcMA2yYC85Ea-_Uk0NxACLcBGAsYHQ/s320/to%2Bdo%2Byou%2Bgood%2Bin%2Bthe%2Bend.jpeg" width="320" /></a></div>
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Today's words from Deuteronomy. This is a global season of wilderness.&nbsp; This is a time we can lean only upon God's provision. And this is a walk of faith that God will bring some good in the end.</div>
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<a href="https://1.bp.blogspot.com/-gXI3pgo84pU/XmyEbfWrRKI/AAAAAAAAWVs/S4x2pcI10Aw-ZnKYpw4kq2edqgnnDR0DwCLcBGAsYHQ/s1600/born%2Bto%2Bwin%2Bstreet.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="960" data-original-width="1280" height="400" src="https://1.bp.blogspot.com/-gXI3pgo84pU/XmyEbfWrRKI/AAAAAAAAWVs/S4x2pcI10Aw-ZnKYpw4kq2edqgnnDR0DwCLcBGAsYHQ/s400/born%2Bto%2Bwin%2Bstreet.jpeg" width="400" /></a></div>
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This street sign is painted a few hundred meters down the road from us. "Born to win" street. Africa may not have resilient health systems, but we do have resilient people. And always, hope.</div>
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(And for another view of life in Bundi, read <a href="https://teammcclure.home.blog/2020/03/04/supporting-the-vulnerable/">this blog</a> about our Orphans and Vulnerable Children scholarship program. Or <a href="http://shickelsinbundi.blogspot.com/2020/02/thoughts-on-year-in-review.html">this one</a> about cross-cultural realities from our BundiNutristionist.)</div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com1tag:blogger.com,1999:blog-8176735909708151146.post-80389477963408855552020-03-12T10:35:00.003-07:002020-03-12T10:35:59.846-07:00Tropical Coronavirus, pandemic views from the African continent<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: large;">Africa is generally last to the table</span>. Last economically, last in health indices, last in control of resources, last in accessibility to education or electricity.<br />
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But at this moment, <b>being last is being best.</b> Unlike times of Ebola, when the rest of the world is frightened of any contact with Africa . . . this time, for now, the only reported African cases are from travellers (mostly from Europe), and African countries are blessedly dark on the coronavirus map. Which is a good thing, but also a tricky thing for those of us with a foot in multiple worlds.<br />
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<b><span style="font-size: large;">So here's some of the complexity of watching a pandemic from afar.</span></b><br />
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Being on the edge of a current Ebola epidemic (which is now almost over, and had 3444 cases and 2264 deaths) and having had a massive measles epidemic (which killed more Congolese children in 2019 than coronavirus has world-wide so far, at least 300,000 cases and more than 6,000 deaths, which we as a human society didn't get too alarmed about sadly) . . . we are not strangers to the importance of paying attention to disease and its prevention. So when the WHO and the CDC and numerous universities issue warnings, and when Lancet starts publishing studies that are peer-reviewed and sobering, <span style="font-size: large;">paying attention is a matter of life and death</span>.&nbsp; The key facts we know are<br />
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<li>The coronavirus that causes COVID-19 is a <b>new one</b>, probably from a bat reservoir that crossed into humans in China.&nbsp;</li>
<li>It is different from common-cold coronaviruses in that no one was immune, and it causes a <b>severe illness in up to 15% of people infected, particularly older adults</b> and people with chronic underlying diseases. Unlike many diseases, infants and children are not the most affected.&nbsp;</li>
<li>The <b>infectivity of this virus is pretty high</b>, it stays on plastic and metal surfaces for days and is easily transmitted by coughs at proximity (6 feet or less). Touching hands transfers the virus person to person, and then touching your face (eyes, nose, mouth) lets it enter your body.</li>
<li>But the infectivity measure is not a fact of nature that can't be changed. Right now it varies depending on the behaviour of people. In most places we are using a number of 2.5, meaning each person infected then transmits to more than 2 more people. That's why the graphs slowly slope up then suddenly shoot to the ceiling. 1, 2, 4, 8, 16 . . . the <b>momentum grows</b> until you have a thousand becoming 2 thousand and quickly tens of thousands.&nbsp;</li>
<li><b>If a disease has an infection multiplier of 2.5, it will eventually infect 60% of a population</b>. Think about that for a minute. That's a lot of people. So even if the rate of dangerous or fatal infections is relatively low (much lower than Ebola, or possibly even lower than measles), just the sheer extent of the spread can make it a big-impact disease. 1% of millions of people is still a lot of deaths.&nbsp;</li>
<li><b>If we change our behaviour,</b> stop traveling, massing together, hugging and touching, coughing into hands, etc. WE CAN GET THAT NUMBER DOWN.&nbsp;</li>
<li>The most important measure we can take to protect ourselves is <b>washing our hands with soap and water </b>or using an alcohol hand cleanser, again and again throughout our days.&nbsp;</li>
<li>The second most important things we can do are: stay home if you're sick, stay away from people who are coughing and sneezing and febrile, clean surfaces touched by a lot of people, etc.</li>
<li>And all of this should be particularly done in care of the older people in our societies, who have much higher (up to 15% in the oldest groups) risks of death from this virus. Trying to INCREASE the time it takes for 60% of the population to be infected spreads the timeline out, which allows the health systems to remain functional, or gives time for investigational therapies to become available.</li>
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<b>So, those are the facts.</b></div>
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Now, there are admittedly a zillion things we do NOT know. For instance, when a country reports a case, or ten, or thirty, is that <span style="font-size: large;">how many cases truly exist</span> or just a factor of the number of tests done? Sadly it seems to be more the latter.&nbsp; For every death, there are probably a hundred or more cases in the population. Another thing we don't know is the exact timing of an infected person being able to infect others. It looks like that timing may include the day or two before symptoms appear. Meaning that well people may be well, or may be a day away from sickness and still able to make others sick. We don't know how long it will take to reach the rest of the world, what the impact will be of all the information blitz and the travel restrictions. We don't know the health impact of the economic downturn.&nbsp;</div>
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And we don't know how long Africa can hold out. Uganda has banned arrivals from 16 countries including the USA; anyone who insists on coming is required to self-quarantine for 14 days. This continent's main advantage is that half our population is under age 15, therefore less likely to get severely ill.&nbsp; Our older people might be healthier than most continent's older people, just to have survived. Poverty might mean less lung damage from smoking. Temperatures routinely get over 30 degrees C, 100 F, which decreases the virus's lifespan on surfaces.&nbsp;</div>
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All that might be outweighed though, by our fragile health system capacity.&nbsp; In the best of times we don't have enough oxygen to supplement kids with pneumonia; what will happen if large numbers of people need it? In the best of times we lack ICU care. IN the best of times our ratios of doctors and nurses to population are frighteningly small.&nbsp; People live in close proximity; social distancing is definitely a counter-cultural stretch.</div>
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Besides the facts, what we know and don't know, there is also the vague cloud of instability.&nbsp; To me this feels like the days after 9/11.&nbsp; We were here in Africa, and felt safer than our families were. It was hard being far away. The wobble of the world was such that there would always be before and after. And that made it hard to think very far ahead. Would travel stay unsafe? Would we be able to see family in the coming months? Similarly, now, our Serge Africa friends are feeling the punch of restrictions.&nbsp; Visitors are canceling. Plans we had for an every-four-years- reunion conference in late May have been canceled. The intersections with our kids and mothers most likely won't happen this summer. These kinds of losses are huge.&nbsp; We feel the exhaustion of decisions, of care, of predicting, of vigilance. We feel the weight of making a mistake that could make us the vectors of bringing disastrous consequences. We feel the likelihood that a crashing stock market will translate into less generous capacity for giving, less funding for Christ School, less emotional space for people to pray for us and care. We feel the anticipatory sadness that further pressure on African systems will mean further instability and death.&nbsp; Most likely, we and our teams and our families will all hunker down and find a new normal and pull through just fine. But the months ahead look trying.</div>
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That's the pandemic view from Uganda tonight, in the rain, with news playing in the background. Tomorrow we'll be back to rounding on too many patients, meeting with staff, struggling for justice, gently caring for the sick, praying for others, and finding the new normal.</div>
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And we will be reminding our own hearts, and yours, that God is with us.</div>
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DrsMyhrehttp://www.blogger.com/profile/06617472350016164272noreply@blogger.com0